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A TREATISE ON HYGIENE.

I. ARCTIC.

III. EUROPEAN

II. MONGOL.

IV. AMERICAN .

PN»

VII. MALAY

VI. HOTTENTOT.

VIM. AUSTRALIAN,

TREATIS^DN HYGIENE

SPECIAL REFERENCE

THE MILITARY SERVICE.

WILLIAM A. HAMMOND, M.D.,

SURGEON-GENERAL U. S. ARMY;

FELLOW OP THE COLLEGE OF PHYSICIANS OF PHILADELPHIA; MEMBER OF THE PHILADELPHIA PATHOLOGICAL
SOCIETY : OF THE ACADEMY OP NATURAL SCIENCES ; OF THE AMERICAN PHILOSOPHICAL \iOCIETY ;
HONORARY CORRESPONDING MEMBER OF THE BRITISH MEDICAL ASSOCIATION; MEMBER
OF THE VEREIN FUR CEMEINSCHAFTLICHE ARBEITEN ZUR riiTITimrnn. TfflTO ' V
WIS8ENSHAFTLICHEN HEILKUNDE; LATE PROFESSOR OF AN^JKjMY
AND PHYSIOLOGY IN THE UNIVERSITY OF MARYLA
LATE SURGEON TO, AND LECTURER ON CLIN-
ICAL SURGERY AT, THE BALTI-
MORE INFIRMARY,
ETC. ETC.

PHILADELPHIA:

J. B.'-LlfrPINCOTT & CO.,

Nos. 715 anI) 717 Market St.
18 63.

all

Entered, according to Act of Congress, in the year 1863, by

J. B. LIPPINCOTT & CO.,

In the Office of the Clerk of the District Court in and for the Eastern District of

Pennsylvania.

JSE
U H

HZZ7t
186.2

MY FRIEND AND FORMER PRECEPTOR,

WILLIAM H. VAN BUREN, M.D.

PROFESSOR OF ANATOMY IN THE UNIVERSITY OF NEW YORK,

irimat* tfeis Wafomt,

IN EVIDENCE OF MY REGARD FOR HIM AS A MAN,

MY ESTIMATION OF HIM AS AN ACCOMPLISHED GENTLEMAN AND PHYSICIAN,

AND MY APPRECIATION OF

THE GREAT AND INTELLIGENT INTEREST HE HAS CONSTANTLY TAKEN

IN ALL THAT RELATES TO THE HEALTH AND 'WELFARE

OF THOSE WHO BELONG TO

THE MILITARY SERVICE OF THEIR COUNTRY.

ERRATA.

Page 52, second line from top, for induced read indicated.

Page 99, fourteenth line from bottom, insert it after what.

Page 169, twelfth line from top, for 1678 read 1078.

Page 211, third line from top, for Louget read Longet.

Page 223, ninth line from bottom, for diphtheria read dyspepsia.

Page 230, eighteenth line from top, for found read formed.

Page 273, seventh line from top, for 40° read — 40°.

Page 273, eleventh line from top, for 39° read — 39°.

Page 289, note, for las read los.

Page 296, ninth line from top, for theories read species.

Page 440, thirteenth line from bottom, for space read year.

PREFACE.

If I had not believed that a great necessity existed for a treatise
upon some of the principal subjects of hygiene, I certainly should not,
in addition to my onerous public duties, have undertaken the task of
preparing the present volume. That a growing attention to the subject
of sanitary science is being manifested, cannot be doubted. The most
intelligent members of the medical profession recognize the principle
that their efforts should be directed more especially to the prevention of
disease than to its cure, and the people, who are rarely slow to compre-
hend matters which it is to their advantage to know, are beginning to
appreciate the same fact.

But while I do not wish to be understood as at all doubting the effi-
cacy of proper medication in the treatment of disease, I am sure that the
curative influences of hygienic measures have been too much neglected,
and that drugs, the traditional actions of which have been positively dis-
proved by physiological and chemical researches, as well as by the
soundest deductions from pathology, are too frequently administered
through a strict adherence to the routine which hinders the develop-
ment of medical science, and cramps the powers of those who labor for
its advancement. One object therefore which I had in view, was to
lay before the profession and those who contemplate entering it some
of the principal facts which bear upon the hygienic condition of man
in causing, preventing, and curing disease.

But I had a still stronger motive to actuate me. The nation had
entered upon a war, for the preservation of its liberties, the most
gigantic ever undertaken in the history of the world. Hundreds of
thousands, from the boy to the old man, had devoted themselves to the
service of their country — men whose value to the State could not be

(vii)

Vlll PREFACE.

estimated, and upon whom its future greatness, both in war and peace,
in a great measure depended. Thousands of physicians had been found
to take the medical charge of the armies created,— many of them well
known for their professional eminence, and others, by far the greater
number, young and inexperienced, though not lacking the will and the
ability to do their whole duty when that duty was pointed out to them.
Many of these latter have now become fully equal to the laborious
service to which they have devoted themselves, and each month adds
efficiency and distinction to the medical corps of the regular and volun-
teer forces of the army.

In the military service, more than any other, a knowledge of the
means of preventing disease and of facilitating recovery by methods
other than the mere administration of drugs is necessary. Armies are
often so situated that their salvation depends upon the knowledge
which the medical officer may possess, and it never happens that some
important application of hygienic principles cannot be made to them by
those who are charged with their medical superintendence.

But though many excellent treatises upon individual hygiene are to
be met with in the French and German languages, there is not one
to be found in the English tongue. The little book of Dr. Pickford
does not profess to go at any length into the subject, and is devoted
almost entirely to the consideration of the meteorological influences ex-
erted upon health, and to the discussion of points of public hygiene;
and the excellent treatise of Prof. Dunglison has for many years been
out of print. As to military hygiene, I know of no other book on the
subject, in the English language, than the capital little manual of Prof.
Ordronaux, of Columbia College, which, though containing many most
valuable hints in regard to the health of the soldier, was not intended
by its accomplished author as a treatise on the subject.

There was no work then to which I could refer those who came to
me for information which I had no time to give them as fully as was
desirable ; and as I had for several years given a large portion of my
leisure to the study of hygiene— rather, however, in a desultory way than
with any systematic objects in view — I concluded to devote the hours
which would otherwise have been passed in rest, in preparing a volume

PREFACE. IX

upon the more important subjects belonging to the science of hygiene,
especially those which have a bearing upon the military service.

It is not pretended that this volume is complete. There are several
subjects other than those considered, such as Occupation, Exercise, the
Excretions, Marriage, Celibacy, etc., which I would have been glad to
have taken up, had I not been convinced that the need for some work
on sanitary matters was imperative ; and therefore, notwithstanding the
imperfect result of my labors — the shortcomings of which no one can
perceive more clearly than myself — I have concluded to stop for the
present, and to defer to a second edition, should such be called for, the
more complete fulfilment of my task, by the consideration of topics not
only interesting in themselves, but important in their bearings upon the
health, the comfort, and the happiness of mankind.

Moreover, I have been restrained from expressing my views fulfy
upon some subjects, for the reason that the immense amount of material
which has been collected in the Surgeon-General's office during the past
year — an amount unprecedented in the annals of military medicine and
surgery, and more even than is contained in the published medical
records of all the armies of the world — is not as yet so arranged as to
be in a form for satisfactory study, and I therefore preferred, both for
my own sake and that of the reader, to delay the consideration of
points which otherwise I should have discussed with insufficient light.
Besides, much important information might have been given in regard
to the relations of medical statistics to hygiene, but for the fact that the
associated matter would have been in many instances of value to the
enemy in a military point of view.

Since this treatise was commenced, events have been developed with
surprising rapidity, and, in consequence, several subjects in regard to
which opportunities for forming definite opinions had not been afforded,
are now matters of fact. Such, for instance, is that of the adaptability of
the negro race for all the purposes of war, which, at the time the chapter
on Race was written, was, in some respects, an open question, but which
has been recently shown to be no longer a subject of doubt. The opinion
then expressed relative to the immunity of this race to attacks of mala-
rious diseases has received additional confirmation from the official re

X PREFACE.

ports which have recently come to hand, from which it appears that
while the white troops are affected to the extent of 10-80 per cent, with
diseases of malarious origin, the negro troops serving in the same army
show only 0-80 of such diseases.

It is only by yielding our opinions to the necessities of the age in
which we live, when every science bearing upon medicine is being-
developed by the labors of thousands of investigators, that we can
claim the right to be regarded as wise physicians seeking only the good
of those committed to our charge, rather than our own personal advant-
age. In science we believe nothing till it is proven, and even then we
should be ready to forsake our most cherished doctrines when the evi-
dence of their instability is forthcoming. If, therefore, I have been
positive in the expression of opinions which are at variance with those
held by others, it is only because I now believe them to be correct. To-
morrow I may renounce them all.

But even in my positiveness, I hope I have not forgotten the pro-
prieties of life, or the forbearance and courtesy which should prevail in
all discussions, especially in those of a scientific character.

Washington City, D. C, June 25th, 1863.

CONTENTS.

PAGE

Dedication v

Preface v ii

Tntkoduction 13

SECTION I.

On the Examination of Recruits.

CHAPTER I.
General Qualifications and Disqualifications of Recruits 18

CHAPTER II.

Special Qualifications and Disqualifications of Recruits 53

SECTION II.

Of the Agents Inherent in the Organism which affect the Hygienic

Condition of Man.

CHAPTER I.
Race * 62

CHAPTER II.
Temperaments in General 77

CHAPTER III.

Particular Temperaments 80

(xi)

Xii CONTENTS.

CHAPTER IV.

PAGE

89
Idiosyncrasy

CHAPTER V.
Age «

CHAPTER VI.
Sex 107

CHAPTER VII.
Hereditary Tendency 11&

CHAPTER VIII.
Habit 122

CHAPTER IX.
Morbid Habits 127

CHAPTER X.
Constitution 145

SECTION III.

Of Agents External to the Organism which act upon the
Health of Man.

CHAPTER I.
The Atmosphere 148

CHAPTER II.
The Accidental or Non-essential Constituents of the Atmosphere 151

CHAPTER III.
Physical Properties of the Atmosphere 195

CHAPTER IV.
Temperature 200

CONTENTS. Xlll

CHAPTER V.

PAGE

Light 206

CHAPTER VI.
Electricity 211

CHAPTER VII.
Water 213

CHAPTER VIII.
Soil 250

CHAPTER IX.
Locality 256

CHAPTER X.
Climate 262

CHAPTER XL
Acclimation 281

CHAPTER XII.
Habitations 304

CHAPTER XIII.
Hospitals 305

CHAPTER XIV.
Principles of Hospital Construction 324

CHAPTER XV.
Field Hospitals 387

CHAPTER XVI.
Lighting of Hospitals 399

CHAPTER XVII.
Heating of Hospitals 409

xiv CONTENTS.

CHAPTER XVIII.

PAGE

Ventilation of Hospitals

CHAPTER XIX.
Barracks

CHAPTER XX.

n 448

Camps

CHAPTER XXI.
Food • 462

CHAPTER XXII.
Alimentary Principles 467

CHAPTER XXIII.
Physiological and Sanitary Relations of Food 494

CHAPTER XXIV.
Animal Compound Aliments 504

CHAPTER XXV.
Vegetable Compound Aliments • 518

CHAPTER XXVI.
Accessory Food 526

CHAPTER XXVII.
Alimentation of the Soldier 556

CHAPTER XXVIII.
Clothing 579

CHAPTER XXIX.
The Hygienic Relations of Clothing with the several parts of the Body 590

Index 597

LIST OF ILLUSTRATIONS.

Frontispiece — Races of Mankind.
Fig. 1. Stetho-Goniometer,

2. Spirometer,

3. Spirometer,

4. Stethometer of Dr. Quain,

5. Manner of using Dr. Quain's Stethometer,

6. Chest Measurer of Dr. Sibson,

7. Manner of using Dr. Sibson's Chest Measurer,

8. Cardiometer,

9. Hremadynamometer,

10. Arrangement for determining effects of Organic

Emanations from the Body,

11. Modifications of Pouchet's Apparatus,

12. Filter of Dr. Cutbush,

13. Fowler's Filter of Charcoal,

14. Mode of using Fowler's Filter,

15. Apparatus for showing Absorptive Power of Soils,

16. Ground-plan of Guy's Hospital,

17. Ground-plan of Necker Hospital,

18. Ground-plan of Hilton Head Hospital,

19. Ground-plan of Marine Hospital, St. Louis,

20. Ground-plan of Hopital de la Clinique,

21. Ground-plan of United States Army Post Hospital,

22. Ground-plan of Victoria Hospital, Netley,

23. Ground-plan of Seminary Hospital,

24. Ground-plan of Good Samaritan Hospital,

25. Ground-plan of King's College Hospital,

26. Ground-plan of Arbour Hill Hospital,

27. Example of Hospital Ward,

28. Ground-plan of Ward for Twenty Beds,

29. Simplest Form of Hospital,

30. Slight Enlargement of Plan of Fig. 23,

31. Ground-plan of Lariboisiere Hospital,

32. Details of Ward of Lariboisiere,

33. Military Hospital at Vincennes,

PAGE

Dr. Scott Alison.

Mr. Hutchinson.

Dr. S. W. Mitchell.

Original.

Dr. Bennet.

Original.

170

174

243

246

247

254

Hasson.

311

312

Original.

313

314

315

316

Husson.

317

Original.

319

Husson.

320

British Blue Book.*

321

a a

327

328

a a

331

Husson.

333

334

British Blue Book.

336

* The work thus designated is the Report of the Commission appointed to inquire into the Sanitary
Condition of the Barracks and Hospitals of Great Britain.

(xv)

XVI LIST OF ILLUSTRATIONS.

Fig. 31. Blackburn Hospital,

35. St. Louis Hospital at Turin,

3G. Proposed Military Hospital at Woolwich,

37. Military Hospital at Malta,

38. Elevation of Boston Free Hospital,

39. Ground-plan of Boston Free Hospital,

40. Ground-plan of Episcopal Hospital, Philadelphia,

41. Details of Ward Pavilion, Episcopal Hospital,

42. Post Hospital at Fort Delaware,

43. Section of Ward Hospital at Fort Delaware,

44. Ground-plan of British Regimental Hospital,

45. Winter Ventilation of Temporary Hospitals,

46. Military Hospital, Judiciary Square, Washington,

47. Ground-plan of West Philadelphia Military Hos-

pital,

48. Details of Ward of West Philadelphia Hospital,

49. Sections of Ward of West Philadelphia Hospital,

50. Ground-plan of Mower Hospital, Chestnut Hill,

51. Ground-plan of Ward Pavilion Chestnut Hill

Hospital,

52. Ground-plan of McClellan Hospital, Philadelphia,

53. Ground-plan of Hammond Hospital, Point Look-

out, " 378

54. Elevation and Ground-plan of a Ward of Ham-

mond Hospital, " 379

55. Sections of Ward and Corridors of Hammond

Hospital, " 380

5G. Poyet's Plan for Hospital, Husson. 381

57. Lincoln Hospital, Washington City. Original. 383

58. Military Hospital at Fort Schuyler, " 385

59. Disadvantageous Manner of Arranging Tents

and Huts, " 391

60. Proper Way of Arranging Tents and Huts, " 391

paot:

Husson.

337

339

British Blue Book.

341

a '<

342

Original.

344

348

350

351

352

British Blue Book.

353

Original.

357

362

<«

365

367

369

373

«<

374

376

61.
62.

392
393

63. Crimean Hut, Brit. San. Com. Rep. 395

64. Ridge Ventilated Hut, « lt ggg

65. Transverse Section of Ridge Ventilated Hut, " " 39(5

66. Ventilation of Gas Burner, Ronalds $ Richardson. 407

67. Ventilation of Gas Burner, British Blue Book. 408

68. Diagram of Hot Water Heating Apparatus, Ronalds $ Richardson. 418

69. Section of Permanent Ridge Ventilated Hospital, Origin, 441

70. Dr. Arnott's Ventilator, British Blue Book 442

71. Ventilation by Flues, Wyman U2

72. Dr. Reid s Plan for Ventilating House of Com-

mons, „ 4W

73. Ventilation of Latrines, Original. 445

74. Hut of the 79th Highlanders, Crimea, Brit. San. Com. Rep 457

A TREATISE ON HYGIENE.

INTRODUCTION.

In order that an army may be effective it must be
healthy, and in order that it may be healthy the men
composing it must be well formed, of good constitution,
free from any disease which can impair their efficiency,
and kept, by physical, mental, and dietetic influences, in
such a condition as will, if it do not entirely prevent dis-
ease, at least reduce the sickness to the lowest possible
minimum. The circumstances under which armies are
placed, when in the field, are usually such as are directly
at variance with hygienic principles. Military necessity,
with greater force than any other necessity, knows no law,
and should know none; but it is rarely the case that a
commander having the good of his troops really at heart,
cannot manage to bring into play those sanitary prin-
ciples which, when properly enforced, add to the com-
fort, the health, and, consequently, the power of his
forces.

To put a soldier into the field costs the government
nearly four hundred dollars; should he die, or become
permanently disabled in service, a pension is given. Look-
ing at the matter therefore merely in a financial point of
view, we perceive that it is a subject of serious importance

2 (13)

14 A TREATISE ON HYGIENE.

that every means should be taken to preserve the lives
and health of those who come forward to fight the battles
of their country.

Since a knowledge of sanitary science has come to be
regarded as an essential part of the education of military
medical men, very great progress has been made in lessen-
ing the mortality of armies. The Secretary of State for
War of the British government, in a recent speech in the
House of Commons, said : —

" Improvements have been introduced with a view to
ameliorate the social, moral, and sanitary condition of the
private soldier. Much expenditure has been incurred for
the sake of enlarging and improving barracks, and in carry-
ing out various recommendations of the House of Commons
with respect to barracks and the hospitals connected with
them. I am happy to say that these efforts have not been
unattended with important results, as will appear from
authentic returns of the mortality in the service. These
returns have been prepared by the Director-General of the
Army Medical Department, and I believe they are per-
fectly authentic, though it is certainly difficult to believe
that so great a change can have taken place in so limited
a period. It is possible that the greater youth of some
portions of the army may, to a certain extent, affect the
returns, but I believe the difference is mainly to be ex-
plained by improvements in the sanitary conditions under
which they are now called on to serve.

"Deaths among the Troops serving in the United Kingdom annually,

per 1000 men.

From 1830 to 1836. 1859 to 1860.

Generally throughout 14

Cavalry of the Line 15

Royal Artillery 15

Foot Guards 21

Infantry of the Line 17

INTRODUCTION. 15

" Similar returns for the Colonies are as follows: —

From 1837 to 1856. 1859 to 1861.

Gibraltar 22 9

Malta 18 1*

Ionian Islands 27 9

Bermuda 35 11

Canada 20 10

Jamaica 128 17

Ceylon 74 27

"I have other returns, from other colonies," continues
the Right Honorable gentleman, "and I believe that these
returns are authentic, and certainly they show how very
considerable a diminution has taken place in the mortality
of the Army, and these results are very encouraging for
future attempts in the same line of improvement."*

These results are certainly very striking, but scarcely
more than was to be expected, when we consider what vast
efforts the British government made to increase the com-
fort and provide for the health of its soldiers after atten-
tion was once directed to the subject. The Crimean war
revealed to the British people the fact that their soldiers
were scarcely as well cared for as the horses that drew the
artillery. Sir John Hall,f Inspector-General of Hospitals,
states, in his evidence before the commission appointed to
inquire into the sanitary condition of the army, etc., that
upon one occasion he made a requisition for a building used
as a stable for mules to be turned over to him as a hospi-
tal for the sick and wounded soldiers. After considerable
correspondence and delay, Sir John announces that the
mules "carried the day!"

* On the Growth of the Recruit and Young Soldier, by William
Aitken, M.D., Professor of Pathology in the Army Medical School,

p. 5.

t Report of the Commissioners on Sanitary Regulations, etc. of

British Army. Appendix, p. 104.

16 A TREATISE ON HYGIENE.

On the conclusion of the war, investigations into the
character of the existing evils were at once commenced. A
commission was appointed to examine all the barracks and
hospitals in Great Britain. Action was at once taken on
their report. Improvements in the way of light, ventilation,
drainage, increased space, etc. were made. Old buildings
were entirely remodeled, new hospitals were constructed in
which every hygienic point was considered without regard
, to expense, until now, British soldiers are as well cared
for, sick or well, as any other class of men in the world.
The results of this enlightened system are seen in the tables
adduced by the Secretary of War, which have been already
quoted. Is it not our duty to profit by the experience of
others, rather than wait to purchase it at our own cost?

The greater number of diseases are, as we shall point out
more at length hereafter, more or less preventable. When
a preventable disease occurs, some one is to blame — either
the subject of it or those who are charged with the duty of
providing for his well-being. It may be, and often is the
case, in military life, that the responsibility which would
otherwise belong to those concerned, is lessened, or even
perhaps altogether removed, by the necessities of war; but
it should nevertheless be the constant effort of all in author-
ity to expose those under their command as little as possible
to morbific influences. The success of well devised measures
in this direction has been strikingly manifested in several
instances during the present rebellion. General Mitchel,
at Hilton Head, and General Butler, at New Orleans, have,'
by the enforcement of proper hygienic precautions, pre-
served the troops under their command from yellow fever.
In the latter city the exemption has been remarkable, as
not a single case of this disease has occurred.

Through the excellent system of ventilation adopted for
our military hospitals, and attention to other sanitary mea-
sures, hospital gangrene has been entirely prevented in

INTRODUCTION. 1 7

them, and erysipelas rendered so infrequent that the occur-
rence of a case excites comment. In European wars both
of these diseases have been the curse of hospitals, and
doubtless were borne in mind by Sir John Pringle* when he
remarked that hospitals were the great cause of mortality
in armies.

A large number of the preventable diseases is due to the
enlistment of persons who are unfit for service, either from
extreme youth, defective development, or the possession of
one or more constitutional predispositions to disease. In a
great measure these pathological influences can be detected
before enlistment, and the service saved the disadvantages
which would otherwise result. Moreover, the good of the
individual himself should not be disregarded. Many per-
sons of tender age would grow up into healthy adults if
not subjected to the hardships of a soldier's life; others,
with arrested development of certain parts of the body,
would live to an advanced age; and many with strong pre-
dispositions to disease would never have this proclivity
lighted up but for the privations and labors incident to
army service. It thus becomes a matter of primary im-
portance to require the most rigid supervision of those
who present themselves for enlistment or who may be
drafted into the army, and I shall therefore not hesitate,
before proceeding to the systematic consideration of the
subject of Hygiene, to point out at length the qualifications
which the recruit should possess in order to be accepted,
and the disqualifications which should lead to his rejection.

* Observations on Diseases of the Army, Am. edition. Preface,
p. xxxiv.

SECTION I.

ON THE EXAMINATION OF RECRUITS.

CHAPTER I.

GENERAL QUALIFICATIONS AND DISQUALIFICATIONS OF RECRUITS.

A weak, malformed, or sickly soldier is not only useless,
but a positive incumbrance. Not only is he incapable of
performing the duty required of him, but his frequent at-
tacks of indisposition demand the services of others in
taking care of him, and add very materially to the immo-
bility which, in a greater or less degree, attends all armies.
The present rebellion has opened our eyes to the evils flow-
ing from the indiscriminate enrollment of men unfit, by
reason of physical infirmities, to undergo the hardships in-
cident to a soldier's life. Thousands of incapacitated men
were in the early stages of the war allowed to enter the
arm}', to be discharged after a few weeks' service, most of
which had been passed in the hospital. Many did not
march five miles before breaking down, and not a few
never shouldered a musket during the whole term of their
service. In a hospital, under my charge, containing six
hundred beds, I discovered at one time, on inspection, fifty-
two cases of inguinal hernia in men who had undergone
but an insignificant amount of exposure to hardship. Cases
of chronic ulcers, varicose veins, epilepsy, and other con-
ditions unfitting men for a military life, came frequently
under my notice. The recruits were either not inspected
at all by a medical officer, or else the examination was so
(18)

QUALIFICATIONS AND DISQUALIFICATIONS OF RECRUITS. 19

loosely conducted as to amount to a farce. I know of
several regiments in which the medical inspection was
performed by the surgeon walking down the line and look-
ing at the men as they stood in the ranks. Not long since
a case was reported to me by an intelligent surgeon, in
which the colonel of the regiment to be inspected refused
to allow the men to be stripped in order to undergo exam-
ination. Matters, however, are better arranged now than
at the commencement of the rebellion; but there is every
reason to believe that sufficient care is yet by no means
taken to prevent the entrance of men into the service who
are rather subjects for the hospital than soldiers fit for the
field.

In consideration of these facts, it will be well to consider
the points which should be insisted upon in passing a recruit,
both with the view of protecting the government and the
individual. It is better to have no soldiers at all than such
as cannot perform the full measure of duty expected of
them. This subject has engaged much more attention in
Europe than in this country, where, owing to the hitherto
small army maintained, it has not been of so great relative
importance. Our army is now, however, larger than that of
any other nation in the world, and it behooves us to add as
much as possible to its efficiency by excluding from it those
who, by careful inspection and consideration of their con-
dition, are found to be unfit subjects for enlistment.

Age of the recruit. — According to the United States
Army Regulations, recruits must be between the ages of
eighteen and thirty-five — exceptions being made only in the
cases of musicians, who may be under this minimum, and
soldiers re-enlisting, who may be over the maximum.

In the French and Prussian services, twenty years is the
minimum age for recruits; in the Austrian, nineteen; and
in the British, eighteen, though boys of fourteen are allowed
(or were not many years since) to enlist for life.

20 A TREATISE ON HYGIENE.

Perhaps the subject of the age of the recruit is more im-
portant than any other. Boys do not make good soldiers,
and men considerably over forty years of age not much better.
The minimum adopted in this country is, we are satisfied,
entirely too low, and even this is by no means adhered to,
soldiers (if they are worthy of the name) being met with —
generally in the hospitals — who have not passed their six-
teenth year. Not long since I saw in one of the general
hospitals a youth of fifteen, who had enlisted as a drum-
mer, but who had been placed in the ranks by his command-
ing officer, and made to carry the entire equipment of a
soldier. The boy succumbed under the multiplied hard-
ships of the Peninsular campaign, and was, when I saw him,
in a condition of debility from which it is doubtful if he
ever rallies so far as to become a healthy and hardy adult.
Cases similar to this are by no means rare. They are found
in all our hospitals, and doubtless in those of every other
army in time of war, for it appears to be impossible, even
when the effort is made, to keep these immature youths out
of the service

A youth of eighteen has rarely attained his full growth.
Dr. Liharzik, of Vienna, as quoted by Dr. Aitken,* in his
little book, already referred to, comes to the conclusion
that the growth of the human body is not completed till
the end of the twenty-fifth year.

Mr. J. M. Dansonf shows that a young man, who has
reached the age of eighteen years, may still be expected to
grow more than two inches before he is fully developed.

Quetelet, from numerous observations on soldiers, came
to a similar conclusion. Tardieu,J in quoting Quetelet's
results, says: —

"It is not si nlocie^Uia^ecruits should be vigorous and
* Op. cit, p. 63.

f Journal of the Statistical Society of London, March, 1862 P ?0
I Dictionnaire d'Hygiene Publique, 1854, t. ii. p. 150.

QUALIFICATIONS AND DISQUALIFICATIONS OF RECRUITS. 21

well made; they should, in addition, be of that age at which
they have acquired all their strength. This age with us
appears to be twenty years. When this rule is violated,
the number of victims is increased without adding to the
strength of the army. A remarkable example of the import-
ance of the age of soldiers is afforded by the campaign of
1805, in which the army marched four hundred leagues to
reach the battle-field of Austerlitz, leaving scarcely any
sick on the road. The youngest soldiers were then twenty-
two years of age, and had been two years in service. In
the campaign of 1809, the army, in cantonments in the
German provinces, had a short distance to march. Be-
fore arriving at Vienna, it had filled all the hospitals
with its sick. More than half of the young soldiers
were under twenty years of age, having been enrolled
prematurely."

Levy* is scarcely less emphatic. Speaking of conscripts
and volunteers, he says : —

" Voluntary enlistments relieve society of men who will
not labor, and who, consequently, are useless. If their con-
stitution is robust and their vocation certain, they become
excellent soldiers, and from their ranks have come many
illustrious generals; but, too frequently, discouragement and
nostalgia ensue upon the enthusiastic love for the profession
of arms. Moreover, at eighteen years, the nervous system
is not consolidated, the pulmonary and digestive mucous
membranes are very irritable ; the organism not having yet
attained to perfection, inadequately resists privations, etc.
In general, the development of man is not attained before
nineteen years, and this limit is prolonged, with many in-
dividuals, to twenty-five years; it follows that the minimum
ao-e for recruits should be rather the twenty-first or twenty-
second year, than between eighteen and twenty years.

* Traite d'Hygiene. Paris, 1850, t. ii. p. 183.

22 A TREATISE ON HYGIENE.

The law has fixed from twenty to twenty-one years for
conscripts, and from eighteen to thirty years for those who
enlist voluntarily. Above thirty years, the habits of life
are too inveterate, and the economy badly adapts itself to
the exigencies of a new life. Over-young recruits have
always had a sad fate. Witness the campaign of the spring
of 1809, in which the army, consisting (to the extent of one-
half) of soldiers twenty years old, strewed the road to Vienna
with its sick; witness also the battles of Lutzen and Baut-
zen, where soldiers eighteen years old fought with vet-
erans."

The results of the battles referred to are matters of his-
tory.

British authorities are fully as explicit on this subject
as the French. Sir George Ballingall* says: —

"The age at which soldiers are enlisted is a point of
much importance, and does not appear to have always met
with that attention which it merits. Upon the principle
of inuring men, from an early age, to those pursuits in which
they are subsequently to be employed, it is generally
thought that we cannot enlist men too young. There is
nothing, however, in the duties of a soldier so mysterious
as to prevent a man possessed of the necessary physical
powers from learning them at almost any period of life;
while, on the other hand, by enlisting boys before their
growth is completed and their constitutions formed, it is
quite impossible to foresee whether they will ever attain
those physical powers necessary to capacitate them for the
duties of a soldier; some of them will, perhaps, turn out
better than we expect, but many of them will, in all proba-
bility, turn out worse, and will ultimately prove a loss to
the service, or what are termed in the army the 'king's hard
bargains.' It has been emphatically observed, that young

* Outlines of Military Surgery. Edinburgh, 1852, p. 29.

QUALIFICATIONS AND DISQUALIFICATIONS OF RECRUITS. 23

men fill the hospitals and not the ranks. ' I demand,' said

Bonaparte, on a very memorable occasion, 'a levy of

300,000 men; but I must have grown men; boys serve

only to incumber the hospitals and the roadsides.'

*******

" Even in the continental armies," continues Sir George,
"in which the troops are employed almost exclusively in
their native climate, similar objections have been made to
young recruits. It was said in derision of the Prince of
Conde's army, that it would be a fine army when it came
of age; and we find both from Kirckhoff and from Coche
that they are decidedly opposed to premature enlistment.
The latter, in his work "De V Operation Medicale du Re-
crutemeirf" states it 'as his deliberate opinion that recruits
at eighteen years of age are commonly unfit for the duties
of the army not only in time of war, but even during
peace.' On the other hand, when men are enlisted for an
unlimited period, it is important that they should not be
admitted at too advanced an age; and upon a full con-
sideration of all the circumstances, I think we may state
that the most eligible period of life for enlistment is from
twenty to twenty-five years of age." * * *

Dr. Luscombe, in an excellent work on the Health of
Soldiers, gives it as his "opinion, founded on observation
and experience, that it is very prejudicial to the efficiency
of an army to admit lads or very young men, for these are
not only unequal to the fatigues of war, but their constitu-
tions not being as yet firmly established, they are almost
certain to suffer greatly from change of climate, and to
become sickly even in the ordinary course of service."

Physiologically there can be no doubt upon the subject.
The youth of eighteen years is immature; his bones are
slender and deficient in the necessary amount of earthy
matter to give them the proper hardness; the epiphyses are
not yet incorporated with the shafts of the long bones, and,

24 A TREATISE ON HYGIENE.

in the ribs, are still cartilaginous; the joints are undevel-
oped, not having yet expanded sufficiently to give firmness
and strength to the limbs; the muscles are soft, and have
by no means acquired their full power, as is shown by the
investigations of Quetelet and others; the chest has not at-
tained its full capacity, and the contained organs have not
yet reached the maximum point of efficiency.

In the digestive organs we find ample evidence of de-
ficient power; substances which a mature man will digest
with ease cause cholera morbus, diarrhoea, or dysentery in
the recruit whose organization is not perfected.

Mentally also the evidences of weakness are frequently
exhibited. While success attends the course of an army,
the soldiers under the adult age are not prone to be de-
pressed and discouraged ; on the contrary, they are often ex-
cessively enthusiastic: but as soon as reverses ensue, or the
food or clothing get to be deficient, or the weather changes
for the worse, melancholy and nostalgia attack them, and
they become at once worse than useless.

The growing age is not therefore that at which the best
soldiers are formed. At this period all the energies of the
body, physical and mental, are required to bring the organ-
ism to its perfect condition. Under the most advantageous
circumstances this state of completeness is frequently not
reached. The individual either succumbs from deficient
vital power, or, as very often happens, certain parts or
faculties of his body are arrested in their development, and
remain in a comparatively degraded condition. How much
more liable one or the other of these results is to ensue
when the subject is exposed, from the vicissitudes of the
military service, to hardships which require all the strength
of the most robust to resist, is scarcely a matter for argu-
ment. Deficient food and clothing, absence of shelter, sud-
den and severe alternations of temperature, winds, snow,
and rain, long marches, work in the trenches, the continued

QUALIFICATIONS AND DISQUALIFICATIONS OF RECRUITS. 25

and tremendous strain made upon all the forces of the body
by battles, the crowding in badly selected, badly policed,
and badly ventilated camps or barracks, bad cooking, bad
water, bad air, all tell with greatly increased violence on
the very young soldier, and ere long send him to the hos-
pital to die, or to be discharged from the service. Scarcely
any such return to their regiments.

Every observant medical officer of the army is cognizant,
from his own experience, of these facts; every hospital in
the service has many examples of them in the persons of
the half-grown boys who are called soldiers, suffering from
organic disease of the heart, phthisis, chronic diarrhoea or
dysentery, rheumatism, debility, scurvy, or nostalgia.

From all this it follows that age is an important point to
be considered in a recruit, and there appears to be no doubt
that eighteen years is altogether too low a minimum.
Place it at twenty to twenty-two, and we shall find fewer
inmates of our hospitals, and consequently more men in
the field; men, too, able to resist disease, to endure fatigue,
and to bear up under the misfortunes and hardships to
which all armies are subject.

In regard to the maximum age at which recruits should
be accepted, the period for which they are required is the
most important point to be considered. In our own service,
where the enlistment was recently for five years and now but
for three, recruits of thirty-eight years of age would, other
things being equal, prove fully capable of rendering efficient
service during the whole period of their engagement. But
they would not make the best soldiers, for the reason prin-
cipally that their habits of life have become set in some
particular direction, rendering them more difficult of in-
struction and discipline than younger persons.

It is quite common, however, to meet with soldiers in
the army who are entirely too old to render effective ser-
vice. These have been brought out by patriotism, and,

26 A TREATISE ON HYGIENE.

consequently, are actuated by the highest possible sense of
duty. They soon find, however, that they have over-
estimated their physical abilities. Often have I seen men
over sixty years of age straggling along on the march,
exhausted with fatigue from exertion, which was far from
being severe for their young companions. Sooner or later
they find their way to the hospitals, suffering from sheer
debility, or crippled from chronic rheumatism.

The regulation is an excellent one — were it adhered to —
which fixes the limit under which recruits for the army
will be received at thirty-five years. Men between this
age and fifty, or even fifty-five, are still capable of doing
less arduous service than is required of an army in the
field. They might be organized into corps for home de-
fense or for garrisoning permanent works; but, as a rule,
soldiers over forty-five years, who enter the service at that
age, are not capable of performing the arduous and severe
duties which devolve upon them in active warfare.

Stature. — All civilized nations have had their attention
drawn to the subject of the height of their soldiers, and all
have fixed a minimum standard of height below which no
recruits are received. The ancients thoroughly understood
the disadvantages resulting from having very small men in
the ranks, for we find that the minimum height for the
Roman soldier was five feet two and a quarter inches,
which is but little less than the American standard, (five
feet three inches,) the highest adopted by any modern
nation except Great Britain.

In the French army the minimum height is at present a
little less than five feet one and a half inches, though for-
merly it was somewhat more than this. In the Austrian
service the minimum is five feet for infantry, five feet one
inch for cavalry, and five feet two inches for artillery. In
the British army the standard is fixed at five feet five
inches.

QUALIFICATIONS AND DISQUALIFICATIONS OF RECRUITS. 27

The disadvantages of soldiers being of very low stature
are very obvious. In the first place, within certain limits
men are strong, and can endure fatigue in proportion to
their height. A soldier of medium height will carry more,
work harder, and last longer than one considerably under
the average stature; but I am satisfied, from much obser-
vation, that too great rigidity has been exercised in ex-
cluding men from the ranks by fixing the minimum stand-
ard at too high a limit. The Austrian soldier five feet
high is fully capable, if of adult age, of enduring the great-
est hardships, and can carry his equipment with as much
ease as the American soldier of six feet and over, although,
perhaps, is not so generally available for service as the man
five feet eight inches high. But if the stature be less than
five feet it will generally be accompanied with such slight
development of the chest and muscles as will unfit the sub-
ject for the labors and fatigues of a military life; and
therefore, as a rule, men under this height should not be
permitted to enter the army.

In our own service the standard of five feet three inches
is at present by no means strictly adhered to. It is not
uncommon to meet soldiers of five feet who have stood
their full share of duty and who are none the worse for it;
and occasionally they are found even below this height,
but broken down by a few weeks' campaigning, and only fit
to be discharged.

Ordinarily the inhabitants of countries where food is
abundant, and where the hygienic conditions of life are
perfectly fulfilled, are of greater stature than those of
localities where the opposite conditions prevail. Under
the latter circumstances it is not only the height that suf-
fers but the muscles are small and weak, the heart feeble,
the lungs contracted, and the brain wanting in that de-
velopment which prompts to courage and activity and dis-
dains hardship. Hence it is that the soldiers of very low

A TREATISE ON HYGIENE.

stature are, as we have said, generally found in the hos-
pitals after a short term of service, debilitated both in mind
and body.

The following table shows the comparative height of
British and French soldiers in proportions of 1000. It is to
be recollected that the British Army Regulations exclude
from the service all persons under the height of five feet
five inches, which accounts for the absence of soldiers under
that stature.

Height.

British
army.

French army,
on authority
of M. Har-
genvilliers.

Height.

British
army.

French army,
on authority
of M. Har-
genvilliers.

Ft.
5
5
5
5
5
5
5
5
5

In.
1

4
114
180

184

156

187

178

152

107

Ft.
5
5
6
6
6
6
6
6

In.

11)

128
73
40
15

7
1
1
1

6....

No one who has seen the French army can have failed
to notice the low stature of the men who compose it. But
at the same time he will doubtless have remarked the fact
that nearly all of them are well proportioned, stout, and
hardy-looking fellows.

The great height of American soldiers is shown by
the following table, in which the results are given for
eighteen hundred men, (one hundred from each State,)
taken in the order in which they were entered in the
Adjutant-General's office. The table is quoted from the
Medical Statistics of the United States Army from 1839 to
1856.

QUALIFICATIONS AND DISQUALIFICATIONS OF RECRUITS. 29

State.

Indiana

Kentucky

Ohio

Tennessee

Maine

Vermont and New Hampshire .
Massachusetts and Connecticut

North Carolina

Georgia

South Carolina ,

Alabama

Virginia

New York

Pennsylvania

New Jersey and Delaware

Maryland

Illinois

Missouri

Mean height.

Feet.

7604

7729

7537

7779

7314

6951

6821

7814

8272

7729

7647

7488

6505

6756

6509

7130

7696

7162

Six feet and over.

Greatest height.

Ft.
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6

In.

4*
4

The great stature of the American, when compared with
that of the English and French soldiers, is made sufficiently
apparent from the foregoing tables. Of one thousand men
in the British army, there were but sixty-five of six feet
and over, and in the French army but four; while of eigh-
teen hundred recruits for the United States army, two
hundred and forty-one were six feet and over in height, or
somewhat more than one hundred and thirty-three per one
thousand. At the time the materials for this table were
collected, no recruit under five feet five inches was ac-
cepted.

Dr. W. H. Thomson, appointed by the authorities of the
State of New York to examine the recruits for the regi-
ments in service from that State, has forwarded to me the
results of his examination of 8632 persons who presented
themselves to him in the City of New York for enlistment.
Of this number but two were under the prescribed height
of five feet three inches. One of these was an American
and one an Englishman; 4500 Americans and 343 Eng-
lishmen were examined.

30 A TREATISE ON HYGIENE.

We have seen that very small men — that is, men under
five feet in height — are not such as make the most efficient
soldiers. Very tall men are often equally objectionable.
Governments have not, however, thought it expedient to
place a limit in this direction, and, therefore, we find more
men of extreme height in service than of diminutive indi-
viduals. The tall soldier, such as one of six feet three
inches, is not, as a rule, robust, and he breaks down much
sooner — other things being equal — than the soldier of be-
tween five and six feet in height. What he has gained in
altitude he has lost in amplitude, and his muscles easily
become fatigued, from the facts that the levers they have to
move are longer than those of his shorter comrade, and
that they relatively do not possess as many fasciculi.

From the comparative narrowness of his chest, his lungs
are inadequate to the work they have to perforin in times
of great activity. Hence he soon becomes " blown," as it is
called.

Tall men are more subject to hernia than those of shorter
stature. This is due to increased length and weight of the
alimentary canal, and to deficiency of tone in the abdominal
muscles.

They afford better marks for the enemy. This is a
matter of no small importance, now that long range fire-
arms are so generally used.

The prevailing opinion among military hygieists is, that
too much desire has been shown to incorporate tall men
into armies. This has been due to an anxiety to obtain
men of imposing appearance, not because they were any
better suited to the requirements of the service. Sir George
Ballmgall,* in alluding to this subject, says : —

"On the subject of stature and of bodily conformation, it
may be observed that crowned heads seem in general to
have a predilection for men of lofty stature and imposing

* Op. cit. p. 31.

QUALIFICATIONS AND DISQUALIFICATIONS OF RECRUITS. 31

appearance; and what are termed the household troops, in
this and other countries, consist of men much beyond the
average height; but such men frequently owe their supe-
riority to an additional length of limb, and are often found
to have defective chests, very disproportioned to the bulk of
their extremities. This renders them, particularly in our
variable climate, subject to pulmonary diseases. I remem-
ber in going around the hospital of the Blues, one of the
most splendid regiments in Europe, to have been much
struck with the number of men laboring under pulmonary
complaints, and was told by Dr. Hair, then surgeon of the
regiment, that he scarcely ever lost a man from any other
cause. Tall men are said to be more subject to disease
generally, and particularly to diseases of the chronic class,
than men of a medium size, and they are frequently the
first to fail under fatigue. Men of this description, there-
fore, are not the most eligible for the general run of mili-
tary duties."

Very tall men do not make the best soldiers physically,
unless their height is accompanied by proportional develop-
ment of the chest and muscular system. Ordinarily per-
sons over six feet three inches in height are not sufficiently
developed in the parts mentioned, and should not accord-
ingly be allowed to enter the service.

It may be supposed that we are over-exclusive in this
particular. It is to be recollected, however, that unless a
man is fitted to perform the duties of a soldier, always
arduous and often extremely severe, he has no business in
the army. Instead of being useful he is a burden. One
able-bodied man is worth a dozen of those who either do no
duty at all or perform their allotted share in an imperfect
manner. The one is to be depended on, the other is alto-
gether unreliable.

Considered physiologically, the subject of the height of
men and the circumstances which influence it are of very

32 A TREATISE ON HYGIENE.

great interest. Some reference has already been made to
it in these connections, but we cannot dismiss the matter
without dwelling upon it with somewhat more of detail,
for we are satisfied that much injury is done both to indi-
viduals and to governments, by allowing persons whose
growth is not completed to enter upon a military life.

The full growth of the human body, in the male, is
scarcely ever attained before the twenty-fifth year; in the
female it is more rapid, and is reached generally by the
termination of the eighteenth or nineteenth year.

Now there are various circumstances which may retard
or hasten this development, and which may arrest it alto-
together — insufficient food and clothing, deprivation of light
and pure air, excessive manual labor, over-exertion of the
mental powers at an early age, want of physical exercise,
the action of a rigorous climate, are all so many counter-
acting agencies to the full attainment of the growth. As
Villerme* remarks, poverty and misery cause a predomi-
nance of persons of low stature, and restrain the complete
development of the body.

The proofs of these assertions are seen everywhere, but
especially in the manufacturing districts of Europe, where
the circumstances mentioned are to be found in full opera-
tion with the production of their legitimate results. In the
department of the Bouches de la Meuse, (now a part of Hol-
land,) a region made rich by the industry and enterprise of
its inhabitants, and where the people are not overworked
in infancy and youth, and are well fed and provided for,
the mean height of the conscripts, in 1808, 1809, and 1810,
under the age of twenty years, was five feet two inches;
while in the department of the Apennines, mountainous,
with no industrial resources, poor, the people broken down

* De le Taille de l'Homme en France. Annales d'Hygiene, tome i.
p. 386.

QUALIFICATIONS AND DISQUALIFICATIONS OF RECRUITS. 33

at an early age by excessive labor, and badly nourished,
the mean height of the conscripts for the three years cited
was but four feet nine inches. Moreover, in the department of
the Bouches de la Meuse, the number rejected was but sixty-
six per thousand, of which forty-two were for diseases, and
twenty-four for being under the height of four feet nine
inches; while in the department of the Apennines, the
number rejected was three hundred per thousand — two
hundred and four for being under size, and ninety six for
deformities, sickness, and other physical disability.

As Villerme, from whose memoir these results are ob-
tained, remarks : " The difference is striking. Where the
height is greater there are fewer rejected, even on account
of diseases; and when, on the contrary, the stature is low,
there are many set aside even for this last cause; so that
all the advantages are with the men of high stature."

The effects of a rigorous climate and a poor soil in dimin-
ishing the height of the inhabitants are seen in the regions
of the frigid zones. It is very rarely the case that the
Greenlanders, Siberians, and other people living in countries
similar to theirs, attain to the altitude of five feet.

We see the operation of the same law in the stunted
vegetation which prevails in high latitudes, and the ex-
treme height to which vegetable organisms grow in equa-
torial regions.

It has been established also that the inhabitants of civil-
ized countries are of greater stature than those of barbarous
regions. Even in the same countries the people have
become taller as civilization has advanced. We hear a
great deal about the physical degeneracy of the human
species in consequence of the increased luxurious mode of
living at the present day, but it may be accepted as a well-
ascertained fact that bodily development is in direct propor-
tion to education, refinement, and intelligence. We see this
law in force in the lower animals and in vegetables, which

34 A TREATISE ON HYGIENE.

always acquire more perfect development by taming and
careful attention.

The researches of M. Villerme* also show, what was not
previously supposed, that the inhabitants of cities are taller
than those of the agricultural districts. The investigations
of M. Queteletf confirm this conclusion. This observer
found that the mean height of the men in three cities of
Belgium, deduced from observations extending over five
years, was in the mean 1*6485 metres, while in the rural
districts it was but 1-6275 metres.

We have said that, as a rule, the growth of the body in
the male is not completed before the twenty-fifth year.
Quetelet not only confirms this law, but even places the
period of full growth at a somewhat later period. At nine-
teen years of age, he found the mean height to be 16648
metres, at twenty-five 1*6750 metres, and at thirty years
1*6841 metres.

As Dr. AitkenJ has very properly remarked, the only
manner of considering the question of height for mili-
tary purposes is with reference to the age. " If the
height of the soldier is the main qualification to be looked
for in selecting the recruit, then the age must be in accord-
ance; for example, if men five feet eleven inches or six
feet are in demand, then the age of such men should be not
less than twenty to twenty-five years, and the weight not
less than 160 to 180 pounds. We know that there are limits
to the rate of growth affixed to the constitution of each in-
dividual, and although men may vary as to height within
certain physiological limits, the age being the same, yet the

* Recherches sur la Loi de la Croissance de PHomme. Ann. d'Hy-
giene, tome vi., 1831, p. 93.

f Sur la Taille moyenne de l'Homme dans les villes et dans les Cam-
pagnes, etc. Ann. d'Hygiene, tome iii. p. 24.

% Op. cit., p. 48.

QUALIFICATIONS AND DISQUALIFICATIONS OF RECRUITS. 35

height of the recruit should never be more than the age
justifies." And again: —

"If eighteen years of age is to be the minimum fixed for
the enlistment of 'growing lads/ then the height should be
as near as possible five feet four inches, and the weight as
near as possible 112 pounds. The height at eighteen years
of age ought not to be below five feet two inches, and cer-
tainly not below five feet. At an age so young as eighteen,
a height below the average is apt to have been the result of
defective feeding in early life, tending to a diminution of
the normal rate of increase and growth of the body. Under
such circumstances stunted development and diseased vital
processes are the inevitable consequences. The constitu-
tional tendencies of the future being are thus more or less
certainly fixed at an early age; and although at the age of
eighteen the recruit may have no evident disease, yet a
minimum height and weight at that age will indicate a de-
cided tendency to constitutional disease. On the other
hand also, as the height approaches a maximum at the age
of eighteen, the excess of growth of the body generally, com-
pared with the expansion, growth, and vital capacity of
the lungs, becomes sufficiently obvious by the contrast of the
tall body with the narrow and flat chest in which the
apices of the lungs approach close to each other. Generally
in such cases the reparative organs are out of proportion to
.the body which has to be sustained."

Closely connected with the height of the individual is
another element in the adaptability of the recruit for mili-
tary service, and that is

The Capacity of the Chest. — No physical point is of
more importance than this. The size of the chest not only
affords us a correct idea of the respiratory power of the in-
dividual, but is a valuable index of his general strength. A
person with an under-sized thorax is generally of strumous
diathesis, a condition of body which indicates deficient vital

36 A TREATISE ON HYGIENE.

power of the whole body, and which, when strongly marked,
unfits the soldier for the thorough performance of his
duties.

Authors differ in regard to the minimum circumference
of the chest which should be insisted on for soldiers. We
are of the opinion that no one in whom the circumference
of the chest immediately over the nipples measures less
than half the height of the individual should be accepted.
Many soldiers are found in service with less capacity of
thorax, but they are weak, puny, and altogether insignifi-
cant, breaking down under the least fatigue, and more fre-
quently found in the hospitals than in the field.

With reference to the external dimensions of the chest
relatively to the height, Mr. Brent* has furnished some very
valuable indications. These may be formularized as fol-
lows : —

Relation of the external chest to the height, measured
over the nipples.

Minimum chest: h of the stature — eV of the stature =
circumference of chest.

Medium chest : h of the stature + T V of the stature —
circumference of the chest.

Maximum chest: f of the stature = circumference of
chest.

To apply these rules to practice, take an instance of a
man five feet one inch in height.

Minimum chest: height 61 inches, i = 30-5 inches

gy = 29*5 inches circumference of chest.

Medium chest: height 61 inches, J = 30'5 inches +
T v ( = 4-07 inches) = 34*57 inches circumference of chest.

Maximum chest: height 61 inches, I = 40*7 inches cir-
cumference of chest.

Taking men of minimum, medium, and maximum weight

* Quoted by Hutchinson. Cyclopedia of Anatomy and Physiology,
art. Thorax.

QUALIFICATIONS AND DISQUALIFICATIONS OF RECRUITS. 37

at various heights, the external circumference of the chest
should be as is shown in the following table.

Males — Circumference of Thorax.

Height.

Ft. In.

5 0..

5 1..

5 2..

5 3..

5 4..

5 5.,

5 6.,

5 7.,

5 8.,

5 9.

5 10.

5 11.

6 0.

Minimum weight.

Medium weight.

Maximum weight.

Inches.

29|

30}

34f

37$

30$

35}

38|

81}

351

31|

36|

39|

32}

40}

32|

37£

33}

«*

33f

38|

42i

341
34f
35}
86|

39}
39|

40i
40$

42|
43}
44
44f

Thus it is seen that the minimum chests increase four-
eighths of an inch for every additional inch of height, the
medium chests a little more than this, and the maximum
chests five-eighths of an inch.

Disregarding height, Hutchinson found, from observation
of 1276 cases, that the circumference of the chest increases
exactly one inch for every ten pounds increase of weight.

Brent also arrived at several other interesting results.
Thus he found that the circumference of the thorax, over
the nipples, is equal to twice the breadth of the shoulders,
measured from point to point. If the caliber of the shoul-
ders therefore be eighteen inches, the circumference of the
chest will be thirty-six inches. Four times the distance
between the nipples is equal to the circumference. Four
times the antero-posterior diameter is equal to the circum-
ference. Therefore the distance between .the nipples is
equal to the depth of the external thorax from before
backward. At the height of five feet nine inches, this
antero-posterior diameter varies from seven and a half
inches to twelve and a quarter inches.

38 A TREATISE ON HYGIENE.

I have been at considerable pains to ascertain the accu-
racy of these measurements, and have arrived at conclu-
sions entirely confirmatory of them. The rules appear to
hold good for all cases in which there is not positive de-
formity. We have therefore very simple methods at our
command for determining the external circumference of the
thorax.

For measuring the circumference of the thorax a gradu-
ated tape may be employed; this is placed around the chest
over the nipples. A more convenient method, however,
is to measure the distance between the nipples with a pair
of dividers, or a graduated rule, and to multiply the re-
sult by four. As we have seen, this gives us the entire
circumference of the chest. For measuring one side of the
chest, one end of the tape should be placed at a point on
the sternum midway between the nipples, and the distance
measured between this point and a spinous process of a
vertebra upon the same plane.

It is important not only that the chest should be large
but that it should be symmetrical. Malformation of the
chest is produced by various causes, such as disease, occu-
pation, or intentional constriction.

Diseases of the lungs, pleura, or heart may make one
side of the thorax larger or smaller than the other. Angu-
lar or lateral curvature of the spine, from disease of the
vertebrae, or a want of tone in the muscles which maintain
the spinal column in an erect position, cause great deformity
of the chest.

What is called "chicken-breast" appears to be due to re-
peated attacks of dyspnoea, or some condition by which a
constant difficulty is experienced in inspiring a sufficient
quantity of air. Dupuytren noticed the occurrence of this
species of malformation in conjunction with enlargement of
the tonsils, and Mr. Shaw,* who was, we believe, the first

* London Medical Gazette, vol. i., 1842.

QUALIFICATIONS AND DISQUALIFICATIONS OF RECRUITS. 39

to study the subject philosophically, confirms this observa-
tion. In a case which came under his charge, in which
"chicken-breast" existed along with tonsillar disease, he
excised the tonsils, with the effect of entirely removing the
deformity of the chest. The rationale of the causation of
this alteration in the shape of the chest is explained by the
fact that powerful efforts are made to inhale air while but
little really enters. In consequence of the great flexibility
of the ribs, in childhood, the atmospheric pressure over-
comes the action of the muscles, and the sides of the thorax
are forced inward, at the same time pushing the sternum
forward.

In clerks, tailors, and others who pursue sedentary occu-
pations which require them to bend forward for lengthened
periods, the chest frequently becomes flattened anteriorly.
In compositors this condition is very generally met with,
and, as a consequence, this class of artisans is very subject
to phthisis and other lung affections.

In very young soldiers who have gone into the field
without much training, flattening of the chest is quite
commonly observed. Here it is due to the constant stoop-
ing forward while marching, in order to secure a better
purchase for the knapsack and other articles of the equip-
ment. Several cases have come under my observation in
which the individuals were straight and with medium-sized
chests previously to entering the army, in whom very con-
siderable flattening of the anterior thoracic wall and round-
ing of the shoulders were produced in a few months from
this cause, with the consequent development of tubercular
disease of the lungs.

f The effect of pressure in altering the form of the thorax
is well observed in those females who wear tightly-laced
corsets. Here the form of the chest is entirely reversed:
instead of the apex being above, it is below.. Cruveilhier
has observed that infants born with the thorax perfectly

A TREATISE ON HYGIENE.

well formed, may have it permanently deformed through
pressure exerted on the sides by the hands of the nurse.

With reference to alterations in the external form of the
thorax, the stetho-goniometer of Dr. Scott Alison* (Fig. 1)
will be found the best instrument with which to ascertain
their extent, though, for practical purposes before enlist-
ment, the eye alone will afford sufficiently accurate data on
which to form a competent judgment.

Fig. 1.

Thus much in regard to the external measurement of
the chest, a means by which we can generally obtain suffi-
ciently correct ideas relative to the capacity for respiration,
in healthy individuals at least, but which, in disease, is not
such as affords exact results.

The capacity of the lungs may be ascertained, with due
precautions in its management, by means of the spirometer
of Mr. Hutchinson. (Fig. 2.)

This consists of a vessel containing water, out of which
a receiver is raised by breathing into it through a tube; the
height to which the receiver is raised indicates the capacity
of the lungs, plus the residual air which cannot be expelled.

According to Hutchinson, the "vital capacity," as he calls
it, is a constant quantity, and is not increased by habit.
It is, however, modified by the following circumstances: —

First, by height; second, by position; third, by weight;
fourth, by age; fifth, by disease; to which we may add

* On Measuring the Configuration of the Chest in Disease.
Archives of Medicine, No. ii. p. 60.

Beale's

QUALIFICATIONS AND DISQUALIFICATIONS OF RECRUITS. 41

sixth, by the state of the stomach as to repletion; and
seventh, by the muscular power of the individual.

Fig. 2.

These circumstances are so numerous, and exercise so
material an influence over the results obtained, that the

42 A TREATISE ON HYGIENE.

spirometer is not regarded as of much value in investigating
cases of disease; and however decided Mr. Hutchinson may
be relative to the results not being under the influence of
habit, we are satisfied that he is mistaken on this point.

Nevertheless the observations of Mr. Hutchinson are
very important, and physiologically teach some very valu-
able truths.*

Fig. 3.

A spirometer, made upon the plan of the dry gas meter,
has been for some time employed in Germany, and was in-
troduced into use in this country by Dr. S. Weir Mitchell.
It is altogether more simple in its management than the
rather clumsy instrument of Hutchinson, and affords fully
as accurate results. (Fig. 3.)

The mobility of the thorax is a point of much import-
ance, and may be roughly ascertained by means of the tape
measure. The tape is passed around the chest over the
nipples, and the measurement made when the chest is dis-
tended to its utmost capacity with air. It is then measured

* See article Thorax, in Cyclopedia of Anatomy and Physiology, for
a full view of Mr. Hutchinson's investigations.

QUALIFICATIONS AND DISQUALIFICATIONS OF RECRUITS. 43

when the air has been as far as possible expired. The dif-
ference gives the mobility. In most healthy men this will be
found to be somewhat over three inches. If it is consider-
ably less than this, disease may with confidence be suspected.

Fig. 4.

For accurately determining the extent of motion of the
chest the stethometer of Dr. Quain, or the chest measurer
of Dr. Sibson, may be employed. Dr. Quain's instrument
(Fig 4) consists of a circular brass box resembling a watch.

A TREATISE ON HYGIENE.

An index, moved by a rack attached to a string, traverses
the dial. One revolution of the index corresponds to one
inch of motion in the chest. The dial is graduated to
hundredths of an inch. To use the instrument, the box is
placed over the sternum and the string carried around the
chest, as shown in the figure. (Fig. 5.)

Dr. Sibson's instrument is constructed on the same prin-
ciple, the index being, however, attached to a pinion in-
stead of a string. (Fig. 6.) The pinion is placed on the

Fig. 6.

nail of the observer's finger, which rests on the chest, and
moves with it, while the body of the instrument is held in
the other hand, as shown in the figure. (Fig. 7.)

QUALIFICATIONS AND DISQUALIFICATIONS OF RECRUITS. 45

The movements of the chest, as indicated by either of
these instruments, are not extensive, and the results do not

Fig. 7.

entirely admit of comparison with those obtained by the
tape measure, and in the manner described. The former
give the mobility of certain parts of the thoracic parietes
only, while the latter determine the relative circumference of
the chest, when the lungs are full of air or emptied, as far
as is possible. Dr. Sibson gives the following table of re-
sults obtained for different portions of the chest, indicated
in one-hundredths of an inch : —

A TREATISE ON HYGIENE.

Instrument applied to —

Center of sternum, between second
costal cartilages

Second rib, near the costal cartilage.

Lower end of sternum

Fifth costal cartilage, near rib

Sixth rib at the side

Tenth rib

Abdomen

Side.

J right

\left

J right

\left

J right

\left

fright

\left

{center < *
[man
right
left

Involuntary

tranquil
respiration.

Voluntary
forced reap)

ration about

3 to
3 to
3 to

2 to

3 to
2 to

25 to 30

100

110

100

Bennett,* in considering the subject, says : —
"In disease it may be observed, as a general rule, that if
the respiratory movements are increased in one place, they
are restrained elsewhere. We have already alluded to the
relation existing between thoracic and abdominal move-
ments. The amount of these may be exactly ascertained
by the chest-measurer. In the same manner, the dimin-
ished movements on one side of the chest in pleuritis, pneu-
monia, and incipient phthisis can be determined &nd com-
pared with the exaggerated motion on the opposite. Thus,
in phthisis, instead of the indication of the instrument,
placed over the second rib on the affected side, moving be-
tween one and one hundred and ten in forced inspiration,
as in health, it may only move between one and thirty. In
making observations with the chest-measurer, considerable
practice and skill are necessary, as in the employment of
all other instruments. It enables us to arrive at great ac-
curacy, and constitutes an extra means of exploration,
without, however, being absolutely necessary for arriving
at a correct diagnosis in every case."

* Clinical Lectures on the Principles and Practice of Medicine, p. 3?.
Third edition. Edinburgh, 1859.

QUALIFICATIONS AND DISQUALIFICATIONS OF RECRUITS. 47

Fig. 8.

The respiratory power of an individual may be ascer-
tained by the cardiometer or the hgemadynamometer. The
former, modified somewhat for its present
use, is represented in Fig. 8. It consists
of an iron bottle, having a hollow arm at
one side, communicating both with the
cavity of the bottle and a glass tube, open
at both ends, to which a graduated scale
is attached. The mouth of the bottle is
closed with a tightly-fitting cork, through
which a brass tube is passed. This tube is
connected with one of India-rubber, having
a mouth-piece. Sufficient mercury is placed
in the bottle to reach the zero on the scale,
and upon applying the mouth to the end
of the tube, and breathing through it, the
mercury rises in the glass tube. Several
points must be 'observed in using this in-
strument. The joints must all be air-tight,
and, above all, care must be taken to exert

ZJCO

only the muscles of the chest, and not those of the mouth
and cheeks. This instrument only measures the expiratory

A TREATISE ON HYGIENE.

power. The haemadynamometer enables us to determine
both the expiratory and inspiratory power, and is therefore
more useful. (Fig. 9.)

Fig. 9.

It consists of a bent tube of glass, attached to a scale *
graduated for both sides. An India-rubber tube is attached
to one end of the glass tube, to which a suitable mouth-

QUALIFICATIONS AND DISQUALIFICATIONS OF RECRUITS. 49

piece is affixed. Mercury is poured into the glass tube till
the zero on both scales is reached. Upon expiring into the
arrangement, the mercury is forced to rise in the opposite
portion of the tube, and is correspondingly depressed in the
portion to which the elastic tube is attached. When the
act of inspiration is performed, the opposite movements of
the mercury take place. The same precautions are requi-
site as in using the cardiometer.

The height to which the mercury may be raised is greater
by expiratory than by inspiratory efforts. A healthy man,
five feet eight inches high, can raise the column of mercury
about three inches by expiration, and about two inches by
inspiration. The former is, however, much more irregular
in its action than the latter, from the fact that the muscles
of expiration perform other functions than that of simply
expelling the vitiated air from the lungs, while those of
inspiration are only concerned in providing for a free
entrance of a fresh supply of air into the chest. The in-
spiratory power is, therefore, that which furnishes the
more valuable indications relative to the health of the
individual.

Height exercises a very considerable influence upon the
inspiratory power. According to my own experiments,
men of five feet eight inches possess it to the greatest ex-
tent. From this point it decreases both as the height de-
creases and increases, which is certainly a very remarkable
fact. Hutchinson has arrived at similar conclusions.

Occupation also influences the respiratory power. Persons
of sedentary vocations have it to a much smaller extent
than those whose business requires much muscular exertion.

The hsemadynamometer employed as referred to is worthy
of being more extensively used in the examination of recruits
than has hitherto been the case.

In this country it has scarcely at all been employed,
though the indications it yields are of the utmost import-

^ 0F

A TREATISE ON HYGIENE.

ance in determining the fitness of an individual for service

'? p where great strength and endurance are required. It is

easy of application, and requires no special training of the
person submitted to examination.*

Weight. — The weight of the recruit is of very consider-
able importance, especially when taken, as it always should
be, in connection with the age, height, and other physical
circumstances. It is very evident that one hundred and
fifty pounds weight, though perfectly sufficient for an indi-
vidual twenty years old, and five feet five inches high, is
not that which should be possessed by one twenty-five
years of age, and six feet two inches in height.

According to Quetelet,f a man does not attain his max-
imum weight till he is about forty years of age; toward
sixty he begins to decline, so that by the time he has
reached his eightieth year he has lost about fifteen pounds.
In the same period his height has fallen three-tenths of an
inch.

Women attain their maximum weight at a later period
than men — toward fifty years of age — but they . lose at
about the same rate.

Immediately before puberty, both men and women weigh
half as much as they will when their development is com-
pleted.

For corresponding heights, American soldiers are not so
heavy as those of European armies. The former do not
grow laterally to the same extent as the last mentioned,
and hence their deficiency in weight. This is the greatest
defect in the physical constitution of our troops — a defect,
however, which, while it makes them less capable of en-

* Mr.' James W. Queen, of No. 924 Chestnut St., Philadelphia, con-
structed for me, two or three years ago, an excellent haemadynaraometer,
which, so far as I know, is the only one ever made in this country.

f Recherches sur le Poids de l'Homme aux diflferens Ages. Annales
d'Hygiene, etc., t. x. p. 5, 1833.

QUALIFICATIONS AND DISQUALIFICATIONS OF RECRUITS. 51

during long-continued fatigue without succumbing to its
influence, renders them more able to perform labors in
which activity and rapidity of movement are necessary.

It is manifestly impossible to fix any absolute minimum
standard of weight for recruits, unless, as we have said, it
be done in accordance with the age. But in this connection
it would be very desirable that a limit should be established
below which no recruit should be accepted. For instance :

A man at twenty years of age should weigh not less than
one hundred and twenty-five pounds. If he weighs less
than this, there is probably some disease, or constitutional
tendency to one, which will render him unable to master
the hardships of military life. Weight is usually accom-
panied with stamina, unless it be due to obesity, which of
itself constitutes a disease.

With a less weight than that indicated for the recruit of
twenty years of age, the chest will be of smaller capacity
than the normal standard, the muscles will be weak and
flabby, and the digestive system lacking in tone; all of
which are disqualifications which, after a short period of
service, will bring him to the hospital, generally never to
return to the field.

Every recruiting rendezvous should be furnished with a
good set of platform scales, capable of turning with a fourth
of a pound when fully loaded, and every person applying
for enlistment should be weighed, and rejected if found
deficient.

From eighteen to thirty-five, (the limits under which re-
cruits are received, according to regulations, into the Ameri-
can army,) the weight gradually increases. There is like-
wise an increase of weight as the height increases. This
should be at least five pounds for each inch of height above
five feet five inches. Placing the minimum weight at this
height at one hundred and twenty-five pounds, and we have
the following scale : —

A TREATISE ON HYGIENE.

Height.

Minimum weight.

Height.

Minimum weight.

Height.

Minimum woight.

Ft. In.

5 5

125

5 10

150

6 3

175

5 6

130

5 11

155

6 4

180

5 7

135

160

6 5

185

5 8

140

6 1

165

6 6

190

5 9

145^

6 2

170

6 7

195

Weak Constitution. — When an individual presents a
feeble development of animal life, as is induced by contracted
chest and deficient weight, together with coldness of the
extremities and a weak circulatory apparatus, we say that
he is of "feeble constitution." Such an individual may,
upon the most careful examination, show no signs of posi-
tive disease, and yet all his functions are performed in such
a manner as barely, with the greatest care on his part to
avoid exposure to every morbific agent, to carry him through
life. When subjected to any influence out of the ordinary
routine of his existence, the effect is immediately seen. The
slightest indiscretion in diet, a change of weather, moder-
ately severe exercise, or the want of his customary rest,
produce an effect upon him which stronger individuals
would not experience.

Such persons are not fitted for army service. Attention
to the rules we have laid down in the foregoing pages rela-
tive to age, height, capacity of the chest, and weight, will
enable us to make a competent judgment in all such cases.

General Aptitude. — An opinion in regard to the general
aptitude of a recruit for military service can only be formed
from a careful consideration of the points which have al-
ready been brought under notice, together with an exam-
ination into his habits and intellectual development. An
immoral, a drunken, or an imbecile or deranged man is
unfit for the army; but besides being free from vices and
of healthy mind, the soldier ought to be so constituted as
to be capable of feeling a lively interest in his profession

QUALIFICATIONS AND DISQUALIFICATIONS OF EECRUITS. 53

and of looking with a genial mind on things around him.
It is, perhaps, impossible to estimate a man's character in
this respect before enlistment, nor, in many cases, even if
ascertained to be altogether unsuitable, would the fact be
sufficient cause for rejection ; but it is difficult to over-esti-
mate the good results, both to the individual himself and
to those about him, which flow from a cheerful and con-
tented disposition. Hardships are under-estimated, fatigues
are unfelt, defeats do not depress, but a healthy morale is
kept up under the most adverse circumstances. Men thus
constituted are invincible ; they encourage each other, and
embolden their generals to attempt undertakings which
would never be dreamed of with an army of grumblers.

CHAPTER II.

SPECIAL QUALIFICATIONS AND DISQUALIFICATIONS OF RECRUITS.

The subjects of inquiry under this head may properly be
considered as indicated by the anatomical division of the
body into regions and organs.

1. The Scalp and Cranium.

2. The Cerebro-spinal Axis.

3. The Eyes and Ears.

4. The Nose.

5. The Mouth.

6. The Neck.

7. The Chest.

8. The Abdomen.

9. The Genito-Urinary Apparatus.

10. The Upper and Lower Extremities.

11. The Skin.

54 A TREATISE ON HYGIENE.

The Scalp and Cranium. — The scalp should be free
from chronic eruption and tumors, and should be well cov-
ered with hair. The existence of favus, pityriasis, eczema,
alopecia, large tumors, ulcers, or extensive cicatrices pro-
duced by great loss of substance, are disqualifying causes
for enlistment, several of them as well for hygienic con-
siderations arising from a regard for the health of the future
comrades of the applicant, as from a conviction of their ren-
dering the individual himself unfit for service. The cuta-
neous eruptions mentioned are liable to spread by contagion,
and are especially difficult of cure. Alopecia is injurious,
from the fact that the head is deprived of its natural cover-
ing, and exposed to cold and heat.

Tumors may be either of the scalp or cranium ; in the
former case they are, if small, of little. consequence, as they
are generally of the encysted variety. If large, however,
they interfere more or less with the efficiency of the soldier,
and are a sufficient disqualifying cause.

Ulcers of the scalp are usually indicative of constitu-
tional disorder, and are due to a strumous or syphilitic
taint.

Cicatrices should be carefully examined, with a view to
ascertaining their cause, and the detection of any injury
which may have been given to the skull. They are always
suspicious. If there has been much loss of substance, the
recruit should be rejected.

The cranium should be examined carefully, in order to
detect any injury or vicious conformation which may be
present. Fractures, if there has been loss of or depression
of bone, should be regarded as unfitting a man for the mili-
tary profession. In many cases a predisposition to epilepsy
or other affection of the brain is engendered. I knew a
case in which the subject had fractured his skull by being
thrown from a railway car. Recovery ensued after long-
continued unconsciousness, and the loss of eighteen square

QUALIFICATIONS AND DISQUALIFICATIONS OF RECRUITS. 55

inches of bone. There was a depression in the scalp over
the right side, in which the hand could be placed. Eighteen
months after the reception of the injury epilepsy ensued.
The fits were very frequent and severe, and in one of them
he expired.

The cranium may be of abnormal form, or of exceedingly
small capacity. In such cases there is usually some degree
of imbecility of mind. It may be considered as a rule, with
scarcely an exception, that the skull of an adult measuring
less than twenty-two inches in circumference, denotes more
or less idiocy.

Tumors of the cranium are always disqualifying causes.
They may be due to a syphilitic taint, but none the less
unfit the possessor for the military service.

Imperfect ossification of the cranial bones of course renders
the subject unfit for service.

The Cerebro-spinal Axis. — Idiocy. — When well marked,
idiocy can always be detected, even by the most cursory
examination. Cases of the admission of idiots into the
army have however occurred, owing, doubtless, to the fact
that there has been no examination at all. Individuals oc-
casionally present themselves for enlistment who, though
not decidedly imbecile, are possessed of such weak intellects
as to prevent their ever becoming efficient soldiers. Such
men should always be rejected. The day when soldiers
were regarded as mere machines has passed away. An in-
telligent man, who knows what he is fighting for, and who
is capable of appreciating the responsibility that rests upon
him, is incomparably a better soldier than one who is inca-
pable of such intellectual action. Moreover, weak-minded
soldiers can never be depended upon to perform the duties
to which they may be assigned. On guard, for instance,
they are not only useless, but positively unsafe ; because
they are incapable of taking an intelligent view of the rela-
tions which surround them.

56 A TREATISE ON HYGIENE.

Idiots are less able to resist the influence of certain mor-
bific agents than those of sane mind. Thus they are more
liable to inflammatory diseases and to those of malarious
origin, and certainly are more deficient in physical as well
as mental power. A tendency to epilepsy is also generally
present.

It is frequently a difficult point to decide, without a
more careful examination than can be given by a medical
officer at an inspection for enlistment, as to the intellectual
capacity of the recruit. Much may be ascertained in doubt-
ful cases, however, by careful questioning in regard to the
parentage and associations of the individual. Where the
parents have been of the same blood, or where the person
has been exposed to those influences which are liable to
cause a degeneration of the intellect, such as bad alimenta-
tion, the excessive use of intoxicating substances, abuse of
the generative organs, or long-continued deprivation — espe-
cially in early life — of the hygienic advantages of air, light,
clothing, etc., he should be rejected as unfit for the profes-
sion of arms.

Insanity requires still more caution on the part of the
examiner, for many insane persons are possessed of suffi-
cient cunning to deceive even those most experienced in
the management of such cases. Monomaniacs especially
are at times exceedingly difficult of detection, and in spite
of the most rigid examination will obtain entrance into the
service. I have seen several, who were very troublesome
to all about them, who had been enlisted without any
examination, and who had to be discharged.

Epilepsy should always be watchfully looked for, as it
entirely unfits the person afflicted for the duties of a sol-
dier. It is much more common than is generally supposed,
and not a few cases are found in the army. No man who
has had an epileptic seizure should be accepted as a recruit,
and all cases of it should be immediately discharged from

QUALIFICATIONS AND DISQUALIFICATIONS OF RECRUITS. 57 '

service. An experienced examiner will rarely have any
difficulty in detecting it in those who have been attacked.

Chorea likewise disqualifies an individual for the army.
In youth this is generally a curable affection, but if it re-
sists treatment till the adult age is attained, it is rarely got
rid of.

Catalepsy and paralysis are also, when present, disquali-
fying causes for enlistment.

Delirium Tremens. — The fact of an individual having
had an attack of this disease does not, we think, unfit him
for military service, unless the seizure has been recent, or the
causes which induced it still exist. If the attack took place
some years previous to the application for enlistment, and
the habits of the recruit have in the mean time been good,
he should be accepted. On the contrary, if he has had re-
peated attacks, and indulgence in the use of intoxicating
agents still continues, he should be unhesitatingly rejected.
We shall return to this subject, and consider it more at
length under another head.

Curvature of the spine, either angular or lateral, indi-
cates constitutional vice or debility, and should lead to
rejection.

Organic diseases of the spinal cord absolutely preclude
admission into the service.

Neuralgia is perhaps best placed under this head. When
severe, it positively unfits the individual for a military life.

The Eyes and Ears. — These organs should be carefully
examined, as on their good condition depends, to a great
extent, the efficiency of the soldier.

Paralysis of the upper eyelid or ptosis is generally incu-
rable, and incapacitates the individual for service.

Tumors of the eyelids, preventing their closure or of malig-
nant character, ectropion, symblepharon, ankyloblepharon,
and trichiasis are likewise disqualifying affections.

Disease of the lachrymal gland, occlusion of the puncta

58 A TEEATISE ON HYGIENE.

lachrymalia, fistula lachrymalis, or swelling of the lachrymal
sac, and occlusion of the lachrymal duct should reject an
applicant for enlistment.

Encanthis, strabismus, and exophthalmia are disqualifying
affections.

Chronic conjunctivitis, granular conjunctivitis, perforation
of the cornea, procidentia of the iris, occlusion of the pupil,
extensive iritic adhesions, staphyloma, hypopium, cataract,
glaucoma, retinal or choroidal disease, and amaurosis should
lead to rejection. Ulcerations of the cornea, unless extensive
and chronic, do not disqualify.

In examining for several of these affections the ophthal-
moscope can be very profitably employed. In fact, it is
indispensable for the detection of some of them.

Myopia, when excessive, should be regarded as a dis-
qualifying affection. Nyctalopia and Hemeralopia, when
permanent, are also causes for rejection.

Blindness resulting from any cause, in one or both eyes,
unfits the man for service.

The diseases of the ear which render a recruit unfit for
the army are not very numerous.

The loss of the external ear, hypertrophy of the concha, or
the presence of malignant, erectile, or large tumors of any
kind, should be regarded as disqualifying causes.

Obliteration or stricture of the auditory canal, puriform dis-
charge when persistent, polypous growths, perforation of the
tympanum, diseases of the Eustachian tube interfering with
the sense of hearing, or deafness arising from any cause,
lessen the efficiency of the soldier, and are sufficient causes
for rejection.

The Nose. — Loss of the nose from violence or disease neces-
sitates rejection. As do also lipomatous and polypous
growths, or ozsena, or any malignant disease. Loss of the
sense of smell alone is not sufficient cause for rejection.

The Mouth. — Cancerous, or erectile tumors of the lips

QUALIFICATIONS AND DISQUALIFICATIONS OF RECRUITS. 59

hare-lip, or loss of any considerable portion of these organs,
require rejection.

Extensive loss of the teeth, especially of the incisors, or exten-
sive caries, and ulceration, or chronic softening of the gums,
necessitate rejection. The importance of these points is, we
think, liable to be overlooked. No one can be healthy whose
teeth are deficient or in bad condition; and soldiers, of all
other classes of men, require that these organs should be
sound. The loss of the front teeth prevents the soldier
tearing his cartridge, and the loss or carious state of the
molars seriously interferes with the proper mastication of
his food, and consequently with the digestive process. An
unhealthy condition of the gums, besides being of itself a
disqualifying cause, indicates a depraved condition of the
general system.

Loss of the tongue, or any portion of it, or hypertrophy of
the organ, require the rejection of the applicant. As do
also cancerous or other extensive ulcerations, or adhesions
to other parts of the mouth.

Fissure of the palate, elongation of the velum, hypertrophy
of the tonsils, when chronic, stricture of the oesophagus, stam-
mering, and dumbness arising from any cause, also involve
the rejection of the recruit.

The Neck. — Extensive cicatrices, causing contraction, such
as those produced by burns, strumous abscesses or tumors,
torticolis,scirrhus,oY other chronic swellings or tumors, goitre,
aneurism, chronic laryngitis, and aphonia are sufficient
causes for rejection.

The Chest. — Malformation of the chest, angular or lateral
curvature of the spine, idcers, or tumors of the thorax are dis-
qualifying causes for service.

Phthisis, chronic bronchitis, haemoptysis, organic diseases of
the heart or lungs, aneurism of the aorta, and asthma render
the subject of them unfit for military service.

Abdomen. Abscess, or tumors of the abdominal walls,

6(3 A TREATISE ON HYGIENE.

aneurism of the aorta, chronic diseases of the abdominal vis-
cera, and hernias of all kinds are sufficient causes for rejec-
tion. The number of men entering the army with hernia
is very great, and though this affection is not always a
cause for discharge from service, it is amply sufficient to
warrant rejection.

Hemorrhoids, prolapsus ani, spasmodic contraction, and
fissure of the anus, stricture, cancerous or other tumor of the
rectum, fistula ani, artificial anus, malformation of the rectum
or anus, or chronic irritation and itching of this part are to
be regarded as disqualifying a recruit for service.

The Genito-Urin^ry Apparatus. — Hypospadias and
epispadias, permanent stricture of the urethra, disease of t/w
prostate, calculus, incontinence of urine, vesical tumors, chronic
inflammation of the bladder, as evidenced by the discharge
of mucus with the urine, prurigo, or eczema of the scrotum,
sarcocele, hydrocele, or varicocele, loss of the testicles, or serious
disease of these organs, (absence of one testicle only, the
other being healthy, is not sufficient cause for rejection,) or
retention of the testicle in the inguinal canal are causes for
refusing to enlist a candidate.

Loss of the penis, cancer, or indurated chancre are dis-
qualifying causes for enlistment.

The Upper and Lower Extremities. — Chronic ulcers,
cutaneous diseases difficult of cure, extensive cicatrices imped-
ing free motions of the limbs, aneurisms, varicose veins, neural-
gia, chronic rheumatism, or its effects, paralysis, contractions,
habitual trembling are sufficient to warrant rejection.

Chronic swellings of the joints of a scrofulous nature,
tumors of a malignant character, or even of a benign nature
if they impede motion, necrosis, caries, interarticular carti-
lages, hydrarthrosis, periostosis, exostosis, or any malformation
of the limbs restraining their free use, such as club-foot,
bandy-legs, or knock-knees, render rejection advisable.

Malformations of the fingers and toes necessitate rejection

QUALIFICATIONS AND DISQUALIFICATIONS OF RECRUITS. 61

if they are of such a character as to interfere with the per-
fect function of the hands and feet. Supernumerary fingers
and toes are only cause for rejection under a like condition.

Loss of the index finger of the right hand, of either thumb,
or of any two other fingers, is cause for rejection, as is
also loss of the great toe, or of all the other toes.

The Skin. — Chronic cutaneous diseases are generally dif-
ficult of cure, and demand rejection if they are at all
extensive or of a contagious character.

In the foregoing brief enumeration of the disqualifying
causes for the enlistment of a recruit, we have only stated
the general action which the examining medical officer
should take, without going into details. He should be
guided by a sound discretion, based upon experience and
study. Surgeons, too, should recollect that what may be a
cause for refusing to enlist a man is not sufficient cause for
discharging from service. In the one case it is necessary
to employ curative means to fit him for a new mode of life
which may fail altogether; in the other, an attempt should
always be made to cure the disease, if it is curable, before
proceeding to discharge ; for the soldier has, in part at least,
learned his duties, and if relieved of his disability would
still be capable of rendering effective service.

We have now considered, as far as our limits will allow,
the physical pre-requisites of the applicant for enlistment.
In the next place we have to treat of those circumstances
which affect his health and comfort after his entry into
service.

N 0TE . M. Boudin {Resume des Dispositions Legates et Reglemen-

taires qui president aux Operations Medicates du Recrutement de la
Reforme et de la Retraite dans VArmee de Terre) has fully considered
the subjects of this chapter, and I have not hesitated to avail myself
of the material he has collected.

SECTION II.

OF THE AGENTS INHERENT IN THE ORGANISM WHICH
AFFECT THE HYGIENIC CONDITION OF MAN.

CHAPTER I.

RACE.

The several races of men are distinguished by great dif-
ferences, so great that they can scarcely be regarded as due
to any other cause than a diversity of origin. Climate, hun-
ger, destitution, depravity, disease, exposure, degradation
will, in the course of time, work many alterations in the
form and aspect of organic beings; but they cannot so alter
original types as to cause a race, whether of plants or ani-
mals, to lose its identity. Thus, the several varieties of
the cabbage are all derived from a wild plant, scarcely edi-
ble, growing on the sea-coast rocks of Great Britain. The
many kinds of apples all come from a common stock — the
crab-apple. The peach, the most luscious of our fruits, has
its origin in the bitter almond of Persia. Yet, however
much these fruits may have varied from the parent growth,
they all evince a tendency to return to the original form
when separated from the influences which have given rise
to the deviation.

So with the various alterations which animals have

undergone, through the action of a changed mode of life,

or a different climate, continuing through several genera-
(62)

RACE. 63

tions. Restore them to their former conditions of existence,
and in a short time the original type is reached. Take, for
example, the sheep. The fleece of this animal consists of
two kinds of wool intermingled : one is formed of coarse,
stiff hairs; the other of short, fine, curly wool. In the
merino sheep this latter is greatly in excess, and hence
the value set upon fabrics made of it; but if the animal is
removed to a colder region than is natural to it, the coarse,
straight hair takes the place of the softer variety, and
the value of the whole growth is lost. Replace the
merino sheep in its native climate, and the latter regains
its predominance.

The turkey, which is found wild in this country, is of a
brownish-black color; by the simple act of domestication it
becomes wholly changed in its markings, and is frequently
met with entirely white. Yet if allowed to run wild again,
the original uniformity of hue is resumed.

Other animals, under like circumstances, become changed
in the form of their ears, the shape of their skulls, or the
character of their horns; but these variations, like the
others we have mentioned, have nothing of permanence
about them. They merely exist while the conditions which
gave rise to them are in force.

Now, with the several races of mankind the case is
altogether different. There are, it is true, certain changes
wrought in the physical appearance of man through un-
favorable climate and the degenerating influences mentioned.
And there are other alterations produced by the action of
agents capable of developing his mental and physical organ-
ization ; but these are quite as transitory in their character
as those which ensue in the lower forms of organic beings
through like causes, and cannot be held to account for the
marked peculiarities which distinguish what are known as
the races of men, any more than they will explain the dif-
ference which exists between the lion and the tiger, the

64 A TREATISE ON HYGIENE.

horse and the ass, or the Polar bear and his grizzly name-
sake of the Rocky Mountains.

Place the Caucasian in the tropics of South America,
Asia, or Africa, and though his skin may become darker
and his hair blacker and coarser, he is nevertheless, though
he remain there for hundreds of years, in no danger of
being taken for an individual of any other race.

The negro for nearly four hundred years has inhabited
America; and yet, except in cases of a mixing of the blood,
he presents the same aspect as his progenitors, whose repre-
sentatives are figured in the monuments of ancient Egypt.
And so with the other races ; their peculiarities are perma-
nent, and are clearly not due to climate or any other cause
than the original impress given to them by the Creator.

It is impossible, in a work of this character, in which the
discussion of such questions as the present is merely inci-
dental, to enter at length into the consideration of this sub-
ject. Enough has been said to invite the attention of the
student to the many interesting points connected with it,
and to indicate the belief which the author entertains in
the diversity of origin of the several races of men.

The views held by Prof. Agassiz upon this subject appear
to be very philosophical, and supported by an array of evi-
dence and probability not capable of being adduced in favor
of any other theory. According to this hypothesis, there
are distinct centers of creation corresponding to distinct
differences existing not only in the fauna, but in the flora
of the world. These centers are collected into realms, as
Prof. Agassiz designates them. These latter are eight in
number: 1st. The Arctic, inhabited by Esquimaux. 2d.
The Asiatic, inhabited by Mongols. 3d. The European,
inhabited by white men. 4th. The American, inhabited by
American Indians. 5th. The African, inhabited by Nu-
bians, Abyssinians, Foolahs, Negroes, Hottentots, and Bosjes-
mans. 6th. The East Indian or Malayan, inhabited by

RACE. 65

Telingans, Malays, and Negrillos. 7th. The Australian, in-
habited by Papuans and Australians. 8th. The Poly-
nesian, inhabited by South-Sea Islanders.

There are thus sixteen races of mankind, each race
being peculiar to the region in which it dwells, and differ-
ing in several important particulars from any other race.

It is not the intention to point out any peculiarities of
these several races, except so far as they relate to those
with which we are, from association, familiar, and such
as have a direct connection with sanitary science. We
shall therefore consider only the European, the American,
and the Negro.

European Race. — The conformation of the European is
very different from that of any other race. This is espe-
cially seen in the size and form of the cranium, the capacity
of the chest, the height and shape of the body, and the
color of the skin and hair.

Dr. Morton, whose ethnological researches are of so much
value, found the mean capacity of the cranium in Europeans
to be 92 cubic inches, in the American Indians 79, and in
negroes 83 cubic inches. His method of measurement was
by filling the skull with small shot, and then emptying these
into a graduated measure.

The form of the skull is also of an elevated type. The
forehead is high, the face oval, the nose prominent and thin,
and the facial angle large, varying from 80° to 85°.

The capacity of the chest is large, and the average height
exceeds that of all other races, being almost five feet
seven inches for males, and five feet five inches for females.

The form of the body is well marked in several important
particulars. The vertebral column is erect, the chest full
and rounded, the flanks small, the arms straight, the hands
small, the abdomen flat, the lower extremities straight, the
calves well developed, and the feet small and well arched.

In the color of the skin the greatest obvious peculiarity

A TREATISE ON HYGIENE.

is seen. This is the only race that has a white skin and
rosy cheeks.

The color and character of the hair are also worthy of
notice. In regard to the former, there is no uniformity,
varying from the red hair of the ancient Germans to the
black hair, gradually becoming more common. In Ger-
many, Sweden, and Norway light hair is generally met
with; while in the southern countries of Europe the black
hair greatly predominates.

Besides these morphological characteristics, the European
race differs from all others in possessing a greater amount
of physical force. It may be accepted as an established fact
that the muscular strength is always greatest in those races
which are well nourished. The experiments of Peron, on
French sailors and natives of Australia and Timor, suffi-
ciently prove this assertion. The results of this observer,
corrected by Freycinet, were as follows : —

Individuals observed.

Manual force.

Tractile force.

155 lbs.
117 "
132 "

342 lbs.
226 "
254} «

From much observation, I am convinced of the manifest
inferiority of the American Indians to the whites in mus-
cular strength.

The capability for resisting the effects of agents prejudi-
cial to health is greater in the European than in any other
race. Though the number of diseases to which its mem-
bers are liable, through the arts and sciences, mode of life,
and other influences of civilization by which they are sur-
rounded, is vastly larger, their mental and physical organi-
zations are so much stronger by reason of the many de-
veloping and sustaining agencies acting upon them, that
morbific forces make much less impression upon them than

RACE. 67

upon individuals of other races less highly favored. The
exceptions to this rule are not many, and will be pointed
out hereafter. Thus, the duration of life is very consider-
ably longer in this race than in any other.

For reasons similar to those above stated, the European
is protected, to a greater extent than individuals of other
races, against the effects of a climate different from that in
which he has been born. He can live and even nourish
in the torrid zone, and can pass winter after winter at the
north pole, without yielding to the high temperature of the
one or the intense cold of the other. The negro, however,
if removed from his native climate to one considerably
colder, generally perishes, after a short time, from tubercular
disease.

Many of the diseases which affect Europeans are due to
other causes than the predisposing influence of race. As
we have said, civilization has brought with it various patho-
logical influences which act upon them alone, because they
only are exposed to them. There is scarcely a disease which
occurs in the European, that will not also attack other
races if placed within the circle of its action, and generally
with much more power.

American Race. — The American Indian is also marked
by strong peculiarities of mind and body. Incapable of
attaining to a high degree of civilization, he is found in
the greatest state of perfection in the forests and plains of
the unsettled portions of the American continent. If his
mind is cultivated, and the comforts of civilization brought
around him, it is always at the expense of his physical

organization.

There are great differences to be observed among the
several tribes of American Indians. Those of the United
States and British America are a well-formed race; tall,
straight, and muscular, though neither so tall nor so strong
as the whites. In Mexico and South America they are far

68 A TREATISE ON HYGIENE.

less imposing in appearance, and the muscular system is
much less developed. The capacity for civilization is, how-
ever, greater. The facial angle of the Indian ranges from
75° to 80°.

The American Indian is prone to affections of the respi-
ratory organs to a greater extent than the whites of the
same region. Cholera and small-pox are specially fatal to
him, and, like many other barbarous nations, he indulges to
excess in intoxicating liquors when he can get them. Deli-
rium tremens is, however, entirely unknown among this race.

Every one who has resided among them must have
noticed this immunity. Sartorius,* speaking of the Indians
of Mexico, says : " The Indian never has delirium tremens,
and yet many of them are habitual drinkers — one may
even say that they are intoxicated half their lives; while
drunkards of the Caucasian race are in a short time irrevo-
cably lost by the poison of alcohol. With nervous fever,
however, it is the reverse. The Indian succumbs to this
more readily than the white; he neither rages nor becomes
delirious, but all energy is wanting, and in a few days he
expires of exhaustion."

The same author also declares that the skin of the In-
dian appears to be less sensitive to heat and cold, and that
injuries and wounds heal with much greater rapidity, and
are attended with less constitutional disturbance, than in
white men.

From the operation of causes which place the American
Indians in a position which is unnatural to them, the race
is, in the northern parts of North America, rapidly becom-
ing extinct. It appears to be impossible for this race and
the Anglo-Saxon portion of the Caucasian race to occupy
the same territory at the same time. The weaker type in-
variably succumbs. On the contrary, in Mexico and other

* Mexico. Landscapes and Popular Sketches. London, 1859, p. 63.

RACE. 69

portions of North and South America occupied by inhabit-
ants of Spanish descent, the Indians maintain themselves
much better, and though they can scarcely be said to
flourish, they are decidedly in a condition far preferable
to that belonging to their more northern congeners.

Idiocy and insanity are less frequent than with Eu-
ropeans. Through exposure and the irregular supply of
nutritious food placed at their command, the American
Indians rarely attain to an advanced old age.

Negro Race. — The negro of this country, it is to be re-
collected, is living in a climate which is altogether foreign
to him. As he is not gifted with the adaptativeness which
the European possesses, he is seen under somewhat adverse
circumstances, so far as his hygienic condition is concerned.

In his native regions, the negro lives in the very lowest
depths of barbarism, and it is here that we should look for
a typical representative. So far as his mental and physical
characteristics are concerned, it is very doubtful if any posi-
tive advance has been made by transferring him to civiliza-
tion. The negro of unmixed blood presents the same prog-
nathous skull, the facial angle of which measures from 70°
to 75°; the same short, coarse, frizzled hair; the same dark
skin and cast of features. The arms are long, the lower
limbs crooked, the calf meager, the os calcis prolonged pos-
teriorly, and the foot lacking the high arch which charac-
terizes this member in the European.

It is not to be denied, however, that the negro is capable
of considerable intellectual and physical development,
though it seems, nevertheless, that he is altogether incapa-
ble of attaining to the highest point in either. By trans-
ferring him to a temperate climate, he has positively lost
rank physically. The proper place to make the experi-
ment of civilization with him is in the climate under which
he has lived for thousands of years. Brought to one such
as that of the United States, he becomes tuberculous just

70 A TREATISE ON HYGIENE.

as do the lions, tigers, and monkeys which are transported
out of their native lands.

Negroes in temperate climates are extremely liable to
phthisis and other scrofulous diseases. They are incapable
of resisting cold weather, and suffer exceedingly from chil-
blains and other affections depending on a languid circula-
tion. Ulcers heal with difficulty, and chronic abscesses are
comparatively frequent with them.

In regard to the predisposition" to phthisis, the statistics
of the British army are very conclusive. In the West
India islands and other British colonies, regiments of negro
troops are maintained in considerable proportion. The fol-
lowing table shows the number of white and negro troops,
per thousand, dying annually of phthisis : —

White troops. Negro troops.

Jamaica T"5 103

Bahamas 60 97

Honduras 30 81

Sierra Leone 6'0 63

Mauritius 40 12-9

Ceylon 49 105

Gibraltar 53 430

We see the effects of climate very decidedly shown from
an examination of this table. In Sierra Leone, the climate
of which is natural to the negro, his mortality from phthi-
sis is not essentially greater than that of the white troops
associated with him, while at Gibraltar it is more than
eight times greater.

But if the negro is more susceptible than the white man
to the diseases mentioned, he possesses a greater immunity
against others. It is a well-ascertained fact that he is much
less liable to affections of malarious origin than the Euro-
pean. He is enabled to work in the rice and cotton fields
of the Southern States with impunity, and yellow fever
rarely attacks him.

ish.

Negroes

•9

8-2

5-6

•7

•6

RACE. 71

The following table shows how much greater the mor-
tality from malarial fevers was among white than negro
troops, during the period extending from 1817 to 1836, in
the colonies specified: —

Engli

Jamaica 101

Bahamas 159

Honduras 81

Sierra Leone 410

Mauritius 1

Ceylon 24

The negro is also less susceptible to the influence of the
syphilitic poison than the white race. I have had many
opportunities of observing how rapidly soft chancres heal
in them, and how lightly and transiently they are affected
by secondary manifestations. Livingstone* asserts that the
negroes of the southwestern part of Africa recover from all
venereal diseases without any treatment whatever, and
that it appears to be impossible to perpetuate syphilis
among them.

Tetanus would seem to be much more common among
negroes than whites, and that singular disease called yaws
is almost peculiar to them.

On the other hand again, they are less subject to nervous
diseases, and bear pain with greater fortitude than the more
finely organized white race.

Negroes are not able to resist low temperatures as well
as the superior races, while, on the contrary, they bear
extreme heat much better.

The American government does not permit the enlist-
ment of negroes in its armies. The English, French,
Spanish, and Danish governments maintain black troops in
quite large numbers. They are, however, much less capa-

* Missionary Travels. London, 1858, p. 128.

72 A TREATISE ON HYGIENE.

ble of enduring fatigue than white troops, though for cer-
tain kinds of service, as for instance in marshy and mala-
rious regions, they might be employed to advantage. As
teamsters they are certainly valuable, and, perhaps, might
be made available as nurses in hospitals. Most of the cooks
in service in the hospitals in Washington City are negroes.*

In regard to other races than those we have specially
referred to, a great many interesting facts are on record.
For instance, Dr. Ewartf shows that the sickness and mor-
tality among the European troops serving in India are very
much greater than in the native troops. Dysentery, cholera,
malarial diseases, and even phthisis, being far more common
among the English soldiers than the Sepoys. But this pre-
disposition on the one part and immunity on the other are
not to be regarded as due so much to the influence of race
as that of climate, and therefore will be more appropriately
considered under another head.

In a very interesting memoir, BoudinJ treats of the in-

* Since the foregoing was written, I have received a copy of the
" Statistical, Sanitary, and Medical Reports " of the British Army for
1860. From this it appears that the proportion, per thousand, dying of
tubercular diseases in 1860, in the troops stationed in the West Indies,
was, for the white troops, 4 '75, and the black troops, 7 '63. The fol-
lowing table also gives interesting results : —

White troops. Black troops.
Ratio, per thousand, constantly sick., -[{g^;;; j?^ g™*

Days. Days.

Mean sick time to each soldier -J}???"' n ' 30 16 ' 33 '

(1859... 19-61 20-03

Average duration of the cases (I860... 11-91 18-29

(1859... 15-92 1MT

f A Digest of the Vital Statistics of the European and Native Armies
in India. London, 1859.

X Essai de Pathologie Ethnique, etc., Ann. d'Hygieue, deuxieme sene,
tome xvi. p. 8, and tome xvii. p. 64.

RACE. 73

fluence of race in causing disease, and among other points
considers the question of the immunity of certain races to
the poison of serpents.

The history of the Psylles is so enveloped in fable that
it is difficult to get at the truth of the stories which ascribe
to them an exemption from the injurious results which
ordinarily follow the bite of poisonous serpents. From
what we know, however, relative to this immunity in
modern times, it may, we think, be assumed that there is
nothing impossible in so much of the tradition as ascribes
to this people a marked indisposition to be injured by the
poison of serpents.

There would appear to be little doubt that the A'issaoua
(a people inhabiting the northern part of Africa) can re-
ceive wounds from poisonous serpents without material
injury. Boudin quotes from Lempriere, Berbruger, and
Bellemarre some very singular statements in regard to
this point, and, without affirming the existence of any such
immunity as that claimed by the above-named travelers for
the A'issaoua, thinks the evidence in support of it is of such
a character as not to be disregarded.

As the result of my own observations, I am satisfied that
the North American Indians can receive the venom of the
rattlesnake into their blood without being subject to the
morbid phenomena to which the whites are liable from a
like injury.

In addition to the influence of race over the production
of disease, we find that there are great differences among
nations in this particular, and that even parts of nations
exhibit peculiarities in this respect. As it is probable that
the influence of climate, soil, and other causes than those
of an ethnological character, are the main agents at work
in producing the susceptibility to some diseases and immu-
nity to others to which we have referred, it will be more
advisable to consider them under other heads.

74 A TREATISE ON" HYGIENE.

Certain races of men have improved their condition;
others, on the contrary, have degenerated. We have seen
that under the influence of cultivation, plants which are
comparatively worthless are developed into flourishing and
esculent vegetables. By processes well understood, domes-
tic animals are rendered larger, stronger, and more prolific;
and others are taken from their natural wild state and con-
verted into docile and useful servants of man, or their tis-
sues are so modified by proper treatment that they become
valuable as food.

Numerous examples of the improvement of races have
been furnished by the history of the world. No one can
doubt the beneficial effects to the effete inhabitants of Italy
from the irruption of the northern hordes of Europe into
that country, or the character of the reaction which these
barbarians themselves received from the intermingling of
blood and the genial influence of a more benign climate
than that they left behind them. Take also the example
of England; first conquered by the Romans, then overrun
by the Danes and Saxons, then entirely subdued by the
Normans. Each infusion of new blood formed an era of
progress, morally, intellectually, and physically. The con-
quest of Spain by the Moors is another instance ; arts flour-
ished, sciences were developed, literature was strengthened.
The conquerors were in their turn subdued and expelled;
had they retained their foothold, Spain at the present day
would have been worthy of them.

In the United States we have the most striking example
of all. Who can doubt that the activity both of mind and
body, the ceaseless energy, the superb physical develop-
ment of the people, are due to the commingling of the blood
of all the nations of Europe? To be an American is to be
a cosmopolitan.

Now, there are several other influences to be regarded.
In order that men should develop, the climate must be

EACE. 75

favorable, the food of good quality and easily obtained, the
clothing sufficient, and the mind kept actively engaged; but
the most active of all causes is that we have alluded to —
the intermixture of blood.

But one race cannot improve another race in this manner.
All the examples we have cited are instances of the en-
grafting of one or more nations on one or more other
nations of the same race. Thus, the Goths, the Vandals,
and the Huns* were of the same ethnological realm as the
nations of the south of Europe whom they conquered; the
Romans, the Saxons, the Danes, and the Normans were of
the same race as the islanders they subdued; the Moors were
as white and as thoroughly Caucasian as the Spaniards
themselves; and the American is the resultant of numerous
nations of the same race. A mixture of the blood of dif-
ferent nations of the same race is better than either of the
parent stocks. Those nations are furthest advanced intel-
lectually and physically which are most thoroughly com-
posite in their character.

When one race mingles with another, a tendency to de-
generation at once manifests itself; and if the races are very
diverse, this tendency is shown in a marked degree. We
see this law strikingly manifested in the offspring of the
whites and Indians, and still more so in the mulatto. Half-
breed Indians are scarcely ever as robust as either of the
races from which they came, and do not possess in the
highest degree the power of procreating the species.
Mulattoes are almost invariably weak and tuberculous,
and possess very little power of procreation. It is gener-
ally the case that the children of parents, both mulattoes,
are sterile.

* I am aware that I lay myself open to criticism in asserting the Huns
to be of the same race as the Goths, Vandals, and other European nations.
The testimony is, however, to my mind perfectly clear on the subject.

76 A TREATISE ON HYGIENE.

In the United States the whites and Indians have not
mixed to any very great extent; but in Mexico and South
America the case is different. In the United States the
whites swept the natives of the country before them. The
Spaniards, on the other hand, endeavored to civilize them.
In the one case they became extinct; in the other, de-
graded.

With reference to the adaptability of races to a military
life, many points of great interest might be brought for-
ward. No doubt, however, can exist relative to the great
superiority of the Caucasian or European race for all the
purposes of war. In endurance, in strength, in courage, in
intelligence, in susceptibility to discipline, in a knowledge
of the art of war, and of the arts and sciences applicable to
war, this race is pre-eminent, and has always, when occa-
sion required, made its superiority apparent.

The American army is composed entirely of Caucasians.
Indians and negroes are not allowed to enter it except as
laborers or servants. The former have occasionally been
employed as irregular troops against the more barbarous
tribes, but no very decisive result has ever attended their
use. As guides and scouts they have often proven to be
excellent auxiliaries. They are altogether incapable of
being brought under military discipline.

The negro, on the contrary, is very readily made to sub-
mit to the constraints imposed by military law. He is
docile, and, as the experience of other nations has shown,
is adapted to certain kinds of service.

Note.— Since the above was written, negro regiments have been in-
corporated into the army. It is probable the experiment will soon be
tried on a larger scale, with what success remains to be seen.

TEMPERAMENTS IN GENERAL. 77

CHAPTER II.

TEMPERAMENTS IN GENERAL.

The ancients laid very great stress on the doctrine of
temperaments, and on the influence which these conditions
of the system were capable of exercising over diseases.
Galen arranged them into four classes, corresponding, as
he supposed, to four different liquids of the body, which,
in their turn, represented the four elements. These four
humors were the bile, the blood, the black bile, and the
lymph; and hence he had the bilious, the sanguineous, the
atrabilious, and the lymphatic or phlegmatic temperaments,
according to the predominance of one or other of these fluids.

We know, however, that no such connection as that sup-
posed by Galen really exists, yet the names given by him
are still those which are in vogue. The individual of san-
guineous temperament has no more blood than the one of
phlegmatic temperament, nor less lymph; neither can these
fluids be supposed at all to influence mental constitution or
physical peculiarities. The same remarks may be applied
to the bile, so that there is no necessary or direct connec-
tion like that assumed by Galen.

But there can be no doubt in regard to the existence of
certain mental and physical types which present certain
distinct characteristics easily recognizable, so that from an
inspection of the aspect and general physical construction
of a man we are enabled to define with tolerable certainty
his psychical peculiarities. These types we call tempera-
ments.

Miiller defines temperament as a peculiar permanent
condition, or mode of mutual reaction of the mind and

78 A TREATISE ON HYGIENE.

organism. I cannot say that the definition is a very clear
or satisfactory one, although perhaps sufficient to indicate
the idea intended to be expressed.

Temperament is rather the organic constitution depend-
ent upon certain mental and physical peculiarities, innate
or acquired. It is the specific difference which gives to
persons, or groups of persons, their individuality. We can
very readily conceive that it must influence very materially
the predisposition to disease. And in fact when we come
to consider the subject in all its bearings and with the pro-
fundity of which it is worthy, we find it very difficult, if
not impossible, to distinguish between temperament and
predisposition. And as we can indicate the intellectual
character of the individual from the color of his hair and
complexion, the size of his hands and feet, or the pecu-
liarities of his pulse and respiration, we are enabled with
as much certainty to designate the diseases to which he is
specially liable from a similar examination.

It is not, however, to be asserted that the temperaments
are separated from each other by strictly defined lines. If
they were, we should probably have more uniformity among
authors in their classification. As it is, a very considerable
diversity exists, some making but two, and others as high
as seven. It is very much with the temperaments as it is
with the colors of the solar spectrum: they overlap each
other and give rise to certain compound temperaments
which possess many of the characteristic marks of distinct
conditions, but which may, without much difficulty, be
separated into their original constituents.

Cullen was able to see but two temperaments, the san-
guineous and the choleric; all others he regarded as combi-
nations of these two. Begin, with more propriety, recog-
nizes three: the sanguineous, the lymphatic, and the
nervous. I agree with several authors in admitting four :
the sanguineous, the lymphatic or phlegmatic, the choleric,

TEMPERAMENTS IN GENERAL. 79

and the nervous. This division is that adopted by Devay,*
and one which appears to be founded on original differences.

The study of the temperaments is, we fear, too much
neglected at this day by physicians, and in the selection of
recruits altogether ignored. I do not intend to be under-
stood as implying that a recruit should be rejected, no
matter what may be his temperament, if he is otherwise
fit to perform the duties of a soldier, but he might be ren-
dered of far greater service to the country by assigning
him to that arm of the service the character of which cor-
responds to his psychical and bodily peculiarities as indi-
cated by his temperament. In the following remarks on
the particular temperaments, I shall again draw attention
to this point.

In examining a patient, as a rule very little attention is
paid to the study of the temperament, although from this
source a flood of light can always be obtained to assist in
determining the diagnosis, the prognosis, and the treatment.
In seeking to ascertain the particular temperament of an
individual, it is necessary to take into consideration not
only his physical peculiarities, but also the mental charac-
teristics he may possess.

" Thus, when it is desirable to acquire valuable informa-
tion in regard to the temperament of any one, in order to
treat him pathologically or hygienically, it is necessary to
refer to some person acquainted with his physiological his-
tory. It is necessary to forget every preconceived idea
relative to the divisions and categories established by
authors, in order to fix the mind on the birth, the former
diseases, the habits, the existing state of the solids and
liquids relative to the forces, that is to say, the combina-
tion of movements which animate the organism — the tend-
ency, the genius of the passions. There is not one of

* Traite Special d'Hygiene des Families, etc. Paris, 1858.

80 A TREATISE ON HYGIENE.

these things that does not act upon the temperament, not
one to which it may not be tributary. It is only after
having decomposed by analysis all the parts which consti-
tute the edifice called the human organization, that it can
be reconstructed so as to present to the view the impress
due to constitution and temperament. And as all these
circumstances vary in each individual, so that each has his
own peculiar manner of feeling and moving, the variety of
temperaments is incalculable. It will be always impossible
to assign them to precise classes."*

CHAPTER III.

PARTICULAR TEMPERAMENTS.

The Sanguine Temperament. — This temperament is
characterized by great activity of the circulatory and respi-
ratory apparatus, and by great vivacity of the mind. The
pulse is quick, strong, and bounding; the complexion florid;
the hair red or chestnut color; the eyes blue; the hands
and feet small; the skin thin and fair; the respiration
active; the digestion good; the excretion from the skin
abundant, while, owing to this latter cause, the urine is
found in small quantity and is high colored. The powers
of endurance are very considerable, though not so great as
in the choleric temperament, not so much from any physi-
cal defects as from mental peculiarities. The expression of

* Devay, op. cit. p. 72.

PARTICULAR TEMPERAMENTS. 81

countenance is cheerful and hopeful, and activity charac-
terizes all the movements.

In the mental constitution we see the same qualities dis-
played, modified, of course, by the different material with
which they are associated. There is the same restlessness
and^brilliancy, and while any particular bent is followed a
good deal of energy is shown. The love of pleasure pre-
dominates, but the pleasure must be frequently varied or
satiety is produced. Inconstancy is the predominating in-
fluence. Good resolutions are formed but to be broken.
Friendships are contracted to be soon abandoned for others,
which in their turn are given up. In love the individual
of sanguine temperament is fickle and faithless, and cares
less for his honor than his pleasure. He engages in great
undertakings without counting the cost, and if difficulties
not estimated for appear, he soon becomes discouraged, un-
less he sees an ultimate advantage to himself from perse-
vering. If success attends his efforts, as it often does, it is
more on account of the rapidity of his actions than the
consequence of any well-laid plans, or else the result of that
"good luck" of which he is frequently the recipient.

History furnishes many examples of distinguished per-
sons of sanguine temperament. Marc Antony and Plato
among the ancients; Charles II. of England, Lorenzo
di Medici, the Duke of Richelieu, and Murat, are in-
stances of it. In this country General Wayne was a gopd
example of this temperament. Shakspeare, in his inimi-
table character of Mercutio, has depicted it with masterly
power. Poetry, painting, and sculpture have their most
distinguished cultivators among individuals of the sanguine

temperament.

Temperate climates afford the most striking instances of
this form of temperament. We see this not only in the
physical characteristics of individuals, but in the history of
the nations which inhabit these regions.

82 ' A TREATISE ON HYGIENE.

The female sex contains more representatives of it than
the male, and youth more than adult or old age.

The diseases to which those of the sanguine temperament
are peculiarly disposed are those connected with the circu-
latory system. Thus they are liable to functional and
organic diseases of the heart, aneurism, and hemorrhages.
Contrary to the generally expressed opinion, I do not believe
in any decided proclivity of individuals of this temperament
to inflammatory affections. Activity of circulation is not
favorable to diseases of this character.

Epidemic and malarious diseases appear to attack per-
sons of the sanguine temperament with more readiness than
others. This may be due to the recklessness of such indi-
viduals, which prevents them taking the ordinary precau-
tions to preserve health. For the same reason it is, per-
haps, that venereal diseases are so much more commonly
met with in them.

At the same time I am of the opinion that there is an
excessive degree of impressibility, which renders the posses-
sors of this temperament extremely liable to certain zymotic
diseases. I have had many opportunities of verifying this
assertion. It is one which, if confirmed by further experi-
ence, cannot but be of importance.

With reference to the adaptability of individuals, accord-
ing to their temperaments, to the requirements of a military
life, little has been written, though it is a question which,
in many respects, is of great interest. Physically, persons
of the sanguine temperament are equal, ordinarily, to any
trial which can be demanded of them. By exercise of the
muscles they become well developed and hard, and that
peculiar modification of the organism known as the athletic
is produced. But the qualities of the mind are also to be
considered. The enthusiasm, the activity, the " dash," which
individuals of sanguine temperament possess, pre-eminently
qualify them for the cavalry arm of the service. Here

PARTICULAR TEMPERAMENTS. 83

they have peculiar opportunities for the display of those
qualities which are inseparable from them, and which are
so essential to good cavalry soldiers. Next to the cavalry,
they are better placed in the light artillery, and next in
the light infantry. They are not the best men for the
heavy infantry or heavy artillery. They are better at
making a charge than in resisting one.

Soldiers of sanguine temperament are valuable as tending
to keep up the spirits of their comrades, for they are hope-
ful, and generally look upon troubles and hardships with
but little seriousness.

The Lymphatic or Phlegmatic Temperament. — This
temperament is the direct opposite of the sanguine in
almost every respect. The flesh is flabby and soft; the
pulse weak and languid; the respiration slow; the counte-
nance pale or leaden color; the eyes green or pale gray,
and expressionless; the hair dry and light colored. The
whole form is rounded, and lacking in that elasticity which
characterizes the sanguine temperament.

Mentally the difference is equally striking. All the
emotions of the mind are slow and indecisive, and rarely,
if ever, of a high or energetic character. The memory is
weak, and the powers of application or of fixing the atten-
tion inconsiderable. There is therefore a disinclination to
reflection, study, or any mental or physical exertion. Men
of this temperament have made but little sensation in the
world's history. The part they have played has been quiet,
unobtrusive, and even insignificant.

But it is not to be supposed that this temperament has
not its good side. Although prompting to slowness, there
is often a perseverance which may compensate for a want
of rapidity. Friendships are not often contracted, but
when once formed are frequently enduring. Great under-
takings are rarely attempted, but those moderate ones
which constitute the bulk of the operations of every-day

84 A TREATISE ON HYGIENE.

life, and which require neither brilliancy nor energy, are
accomplished without bustle or confusion.

As Miiller remarks, the subject of the phlegmatic tem-
perament may be a very useful and trustworthy member of
society. "When rapid action is required, the phlegmatic
person is less successful, and others leave him behind; but
where no haste is necessary and delay is admissible, he
quietly attains his end, while others have committed error
upon error, and have been diverted from their course by
their passions. The phlegmatic person knows his proper
sphere, and does not trespass upon that of others, or come
into collision with them. From this conduct, as well as
from an orderly and steady course of action, in which he
keeps his object in view and avoids self-deception, he de-
rives a contented tone of mind, free alike from turbulent
enjoyments and deep suffering."*

Cold and damp climates are those in which this tempera-
ment is most generally met with.

Old age more frequently exhibits it than youth.

The diseases to which those of lymphatic temperament
are especially predisposed are such as are due to weakness
and relaxation of the tissues, together with feebleness of
the circulation. Thus inflammations — particularly those
of a low and chronic character, attacking in preference the
mucous membranes — are frequently encountered in subjects
with this temperament. Scrofulous affections, such as de-
generation of the lymphatic glands, tuberculous inflamma-
tions of the joints, tuberculous deposits in the lungs, and
skin diseases, are common, as are also dropsical affections.

As far as my observation extends, individuals of lym-
phatic temperament are not especially liable to malarious
diseases, or to be the subjects of epidemic or contagious
diseases, with the exception of influenza, to which they
appear to be particularly disposed when it is prevailing

* Elements of Physiology, edited by Dr. William Baly, vol. ii. p. 1408.

PARTICULAR TEMPERAMENTS. 85

The lymphatic temperament is not that which should
predominate in soldiers. Certain combinations of it, to
which we shall hereafter allude, do very well, but when it
is of the pure type it ill comports with the qualities which^
a soldier should possess. Men of this organization are bet-
ter in the heavy artillery arm of service than in any other
arm. For the cavalry arm of service, or any other in which
daring and elan are required, they are not suited.

The Choleric or Bilious Temperament. — The physical
and mental characteristics of this temperament are exceed-
ingly well marked. The complexion is dark or sallow; £he
hair black or a dark brown; the eyes black or hazel; the
skin dry and not over soft; the flesh hard and firm; the
pulse strong, hard, and frequent; the respiration deep and
strong, and the whole form thin, tough, and wiry.

Mentally the man of choleric temperament is character-
ized by firmness, decision, and determination. His mind is
quick and active; his perseverance carries him over all
difficulties. He is irritable, sensitive, and often vindictive
and cruel. "Bold in the conception of a project, constant
and indefatigable in its execution, it is among men of this
temperament we find those who, in different ages, have
governed the destinies of the world; full of courage, bold-
ness, and activity, all have signalized themselves by great
virtues or great crimes, and have been the terror or admira-
tion of the universe. Such were Alexander and Julius
Csesar, Brutus, Mahomet, Charles XII., the Czar Peter,
Cromwell, Sixtus V., Cardinal Richelieu.

"As love is in the sanguine, so ambition is in the bilious,
the governing passion. Observe a man who, born of an
obscure family, long vegetates in the lower ranks. Great
shocks agitate and overthrow empires; at first a secondary
actor in those great revolutions which are to change his
destiny, the ambitious man hides his designs from all, and
by degrees raises himself to the sovereign power, employ-

86 A TREATISE ON HYGIENE.

ing, to preserve it, the same address with which he raised
himself to it. This is. in few words, the history of Crom-
well, and of all usurpers.

"To attain to results of such importance, the profoundest
dissimulation and the most obstinate constancy are equally
necessary; these are, further, the most eminent qualities
of the bilious. No one ever combined them in higher per-
fection than that famous pope who, slowly traveling on
toward the pontificate, went for twenty years stooping, and
talking forever of his approaching death, and who, at once
proudly rearing himself, cries out, 'I am pope!' petrifying
with astonishment and mortification those whom his artifice
had deceived into his party.

" Such, too, was Cardinal Richelieu, who raised himself to
a rank so near to the highest, and was able to maintain
himself in it : feared by a king whose authority he estab-
lished; hated by the great, whose power he destroyed;
haughty and implacable toward his enemies, ambitious of
every sort of glory, etc.

"The historians of the time inform us that this celebrated
minister showed all the customary signs of the bilious tem-
perament. Gourville tells us he was all his life subject to
a very troublesome hemorrhoidal discharge."*

The choleric temperament is more frequently encountered
in the inhabitants of the warmer portions of the temperate
zone than in other localities.

The diseases to which individuals of the choleric tempera-
ment are particularly predisposed are those connected with
the liver and other organs of digestion. They are, of all
others, especially liable to malarious affections, such as the
various forms of intermittent and remittent fevers, typhoid
fever and dysentery; dyspepsia and internal congestions
often attack them, and hemorrhoids are not infrequent.

* Richerand's Elements of Physiology, edited by Dr. Copeland. Am.
ed., p. 310.

PARTICULAR TEMPERAMENTS. 87

Both mentally and physically the individual of choleric
temperament is admirably qualified for military service.
His obstinacy and energy are qualities which cannot be
overestimated. As we have seen, some of the most cele-
brated soldiers of the world have been of this temperament,
and the list might readily be extended.

The Nervous Temperament. — In this temperament the
manifestations of nervous action give an impress to the
whole body. The countenance is usually pale, and the
features thin and sharp; the pulse is quick, small, and fre-
quent; the respiration active; the chest not largely devel-
oped; the skin dry and rough, and the digestive functions
performed irregularly. The urine is generally copious and
of pale color.

As the muscular system is not fully developed, persons
of this temperament easily become fatigued.

The intellectual operations of those of the nervous tem-
perament are rapid and brilliant, but, at the same time,
not often persistent. Variety is constantly sought for; the
mental efforts, like the physical, are, as it were, spasmodic,
full of energy while they continue, but soon yielding to
others.

Women are much more frequently the subjects of this
temperament than men. It is often acquired by habit of
thought or mode of life, and is seldom met with among
barbarous nations, the whole spirit of civilized institutions
predisposing to its formation.

Voltaire, and Frederick the Great of Prussia, are notable
examples of the nervous temperament. John Randolph,
perhaps, affords the most remarkable example of it among
distinguished Americans.

The diseases which are most apt to occur among indi-
viduals of the nervous temperament are those having an
intimate relation with the nervous system. Thus we have
chorea, hysteria, catalepsy, monomania, and mania. In

88 A TREATISE ON HYGIENE.

fact, the nervous temperament itself is almost a pathologi-
cal condition. The sensibility is so acute, and the system
so readily thrown into disorder from slight causes, that the
temperament in question may well be considered as the
first manifestation of disease.

Individuals of strongly-marked nervous temperament are
altogether unsuited to engage in a military life. The want
of development in the muscular system, together with the
great preponderance of the nervous organization, tend too
much to the conditions above mentioned. With the best
intentions in the world, they are not to be relied on. I
have seen several well-marked cases among officers and
men of the army, and am cognizant of not a few ludicrous
events, or rather what would have been ludicrous but for
the consequences, which, however, were of a more serious
character.

As has been said, it rarely if ever happens that the tem-
peraments are so clearly marked that any one individual
can be said to possess the traits of one without being en-
dowed with several attributes of some other. Thus, there
are the sanguineo-lymphatic, the sanguineo-choleric, the
sanguineo-nervous, and so on. Each of these conjoins
in itself the manifestations of the temperaments of which
it is composed in an equal, or nearly equal, degree, or
the traits of one may very decidedly predominate, in which
case it is named accordingly.

In addition, there are certain conditions which are de-
generations of the temperaments. Thus there is the pleth-
oric state founded upon the sanguineous, the obese on the
lymphatic, and the melancholic on the choleric. These
conditions may properly be considered as positive diseases
and as such calling for medical intervention.

IDIOSYNCRASY. 89

CHAPTER IV.

IDIOSYNCRASY.

By idiosyncrasy we understand a peculiarity of constitu-
tion by which an individual is affected by external agents
in a manner different from mankind in general. ^Thus tf
some persons cannot eat strawberries without a kind of
urticaria appearing over the body, others are similarly
afflicted by eating the striped bass, others again faint at
the odor of certain . flowers, and some are attacked with
cholera morbus after eating certain shell-fish. Many
other instances might be adduced, some of them of a very
curious character. These several conditions are called
idiosyncrasies.

M. Begin, who defines idiosyncrasy as due to the pre-
dominance of an organ, of a viscus, or a system of organs,
has hardly, I think, fully grasped the subject. It is some-
thing more than this; something inherent in the organiza-
tion of the individual, of which we only see the manifesta-
tion when the proper cause is set in action. We cannot
attempt to explain why one person should be severely mer-
curialized by one grain of blue mass and another take daily
ten times this quantity for a week without the least sign of
the peculiar action of mercury being produced. We only
know that such is the fact, and were we to search for the
cause with all the appliances which modern science could
bring to our aid, we should be entirely unsuccessful. Ac-
cording to Begins idea, we should expect to see some re-
markable development of the absorbent system in the one
case, with slight development in the other; but even were
such the case it would not explain the phenomena, for when
ten grains of the preparation in question are taken daily,

90 A TREATISE ON HYGIENE.

scarcely a day elapses before mercury can be detected in
the secretions, and yet hydrargism is not produced, while
when one grain is taken and this condition follows, the
most delicate chemical examination fails to discover mer-
cury in any of the fluids or tissues of the body.

Begin's definition scarcely separates idiosyncrasy from
temperament, whereas, according to what would appear to
be sound reasoning, based upon an enlarged idea of the
physiology of the subject, a very material difference exists.
Persons may be alike in temperament, but there never were
two individuals with the same or even similar idiosyncrasies.
Idiosyncrasies are often hereditary and often acquired.
Two or more may exist in one person. Thus there may
be an idiosyncrasy connected with the digestive system
and another with the circulatory system.

An idiosyncrasy may be of so important a nature as
to altogether unfit an individual for the duties of a soldier,
or it may be of an entirely insignificant character. By
perseverance some idiosyncrasies may be completely over-
come. I knew a gentleman who could not eat soft crabs
without experiencing an attack of diarrhoea. As he was
exceedingly fond of them he persevered in eating them,
and, after a long struggle, succeeded in conquering the
difficulty.

Individuals with idiosyncrasies soon find out their pecu-
liarities, and are enabled to guard against any injurious
results to which they would otherwise be subjected but for
the teachings of experience.

Idiosyncrasies may be temporary only, that is, due to an
existing condition of the organism, which, though natural
or morbid, is of a transitory character. Such, for instance,
are those due to dentition, the commencement or cessation
of the menstrual function, pregnancy, etc. These are fre-
quently of a serious character, and require careful watching;
but when the condition which has given rise to them has

AGE. 91

passed away, the idiosyncrasy generally, but not always,
likewise disappears.

Some conditions, often called idiosyncrasies, appear to be,
and doubtless are, due to disordered intellect. But they
should not be confounded with those which are inherent in
individuals aside from mental derangement. Frequently
they are merely imaginary, there being no foundation for
them except in the perverted mind of the subject; at other
times they are induced by a morbid attention being directed
continually to some one or more organs or functions. Thus
the protean forms under which hypochondria manifests
itself are rather due to the reaction ensuing between men-
tal disorder on the one part and functional disorder on the
other, than to that quasi normal peculiarity of organization
recognized as idiosyncrasy.

The idiosyncrasies of individuals are not matters for ridi-
cule, however whimsical they may be; on the contrary,
they deserve and should receive the careful consideration
of the physician, for much is to be learned from them both
in preventing and treating disease.

CHAPTER V.

AGE.

Time, which exercises its influence even upon inorganic
bodies, is immeasurably more powerful in its relations with
organized beings. They spring into existence, increase,
decay, and die, according to the laws of their being. In
some the cycle is completed in a few days, in others in a
few years, and in others again not until centuries have

92 A TREATISE ON" HYGIENE.

elapsed. This is true equally of animals and plants. The
moth of the silk-worm, and certain species of cryptogamic
plants measure the period of their existence by hours, while
the alligator and the oak count hundreds of years of life.

The length of human life is fixed by the Scriptures at
fourscore years as a maximum. Flourens believes the
natural life of man to be one hundred years, and adduces
many ingenious arguments in support of his opinion. In-
stances are not wanting in which even this limit is greatly
exceeded.

During life the fluids and tissues of the body are con-
stantly undergoing change. New matter is deposited, and
the old is removed with ceaseless activity. The body may
be regarded as a complex machine, in which the law that
force is only generated by decomposition is fully carried
out. Every motion of the body, every pulsation of the
heart, every thought which emanates from the encephalon,
is accompanied by the destruction of a certain amount of
tissue. As long as food is supplied in abundance and the
assimilative functions are not disordered, reparation pro-
ceeds as rapidly as decay, and life is the result; but should
nutrition be arrested by any cause for any considerable
period, new matter ceases to be formed, and the organs,
worn out, act no longer, and death ensues.

The animal body diners from any inorganic machine in
the fact that it possesses the power of self-repair. In the
steam-engine, for instance, the fuel which serves for the
production of steam, and, subsequently, for the creation of
force, can do nothing toward the repair of the parts which
have become worn out by use. Day by day, by constant
attrition and other causes, the engine becomes less perfect,
and eventually must be put in order by the workman. In
the animal body, however, the material which serves for
the production of force is the body itself, and the sub-
stances which are taken as food are assimilated, according

AGE. 93

to their character, by those organs and parts which require
them.

The body is therefore undergoing continual change. The
hair of yesterday is not the hair of to-day; the muscle which
extends the arm is not identically the same muscle after as
before its action; old material has been removed and new
has been deposited to an equal extent; and though the
weight and form, the chemical constitution, and histological
characters have been preserved, the identity has been lost.
So long as these two actions exactly counterbalance each
other life continues. If it were possible so to adjust the
repair to the waste that neither would be in excess, there
is no physiological reason why life, if protected against acci-
dents, should not continue indefinitely. But this is not,
with our present knowledge, possible, and consequently de-
composition eventually becomes predominant, and death
from old age results.

The life of man has been variously divided, by different
authors, into artificial periods or stages, the limits of which
are by no means accurately marked. Thus Haller made
five periods : 1st, first infancy, extending from birth to the
7th year; 2d, second infancy, from the 7th to the 13th or
15th year; 3d, puberty, extending in females from the 13th
to the 21st year, and in males from the 15th to the 25th
year; 4th, virility, lasting in women from the 21st to the
50th year, and in men from the 25th to the 60th year; and
5th, old age, which extends from the 60th year to death.

Richerand divides the life of man into four stages : in-
fancy, puberty, manhood, and old age. Daubenton makes
six divisions : infancy, extending from birth to the period
of puberty; adolescence, from puberty to the 20th or 25th
year; youth, which embraces the period between the 25th
to the 30th or 35th year; the age of virility, which extends
to the 40th or 45th year ; the age of decline, which lasts to

94 A TREATISE ON HYGIENE.

the 60th or 65th year; and old age, which terminates in
death.

All these divisions are purely artificial, and marked by
no well-defined boundaries. A natural division, which is
based upon the physiological course of the life of man, is
not only more convenient but more correct. In accordance
with this principle therefore I should divide the life of man
into three periods: 1st, the period of increase, in which the
formation of tissue predominates over decay; this stage ex-
tends from birth to about the 25th year, varying according
to individual and sexual peculiarities ; 2d, the period of
maturity, in which the processes of regeneration and waste
are counterbalanced, extending from the 25th year or there-
abouts to the 35th year; 3d, tlie period of decay, in which
the tissues are not regenerated as fast as they are broken
down and excreted from the system, and reaching from the
35th year to the extreme limit of human life.* We shall find
that each of these stages is marked by strong peculiarities,
both of organization and action, and that they exhibit im-
munities to some diseases and susceptibilities to others which
are only to be accounted for by a reference to the physio-
logical condition by which each stage is characterized.

The Period of Increase. — The average height of the
human subject at birth is between eighteen and nineteen
inches, and the weight about seven pounds. The bones are
not yet completely ossified, the muscles are soft, the skin
thin and highly vascular, and the circulatory and nervous
systems developed to a much greater comparative extent
than at any other period of life. The development of the
height and weight with reference to the age of the indi-
vidual have already been considered, and need not there-
fore detain us now.

* This division, which is as old as Aristotle, is preferable to any which
has been since devised.

AGE. 95

A great tendency exists, during the first five years of the
period of increase, to diseases of the nervous system, and
this is at its maximum during the first dentition. Convul-
sions due to irritation, and inflammation of the brain and
its membranes, are, accordingly, of common occurrence.
Affections of the digestive system, induced also by the ex-
cessive irritability of the nervous system, are also frequently-
met with at this time.

The respiratory system in very young children exhibits
likewise a strong proclivity to inflammatory diseases. Pneu-
monia and bronchitis are readily induced by exposure to
very slight changes of temperature. Croup is pre-eminently
a disease of early childhood, the tendency to it decreasing
after the second year, at which period it is greatest.

Villerme,* quoting from M. Duvillard, and referring to
the epidemic in Copenhagen in 1825, shows that small-pox
is more frequently fatal to the young than the adult. The
former he also states to be more susceptible to malarious
influences. Scarlet fever, measles, hooping-cough, mumps,
and other contagious diseases, are far more liable to attack
children than adults.

Malgaignef found by calculation that hernia occurred
much more frequently with the young than with the mid-
dle-aged or old. This is doubtless correct, and is readily
explained by the fact that the inguinal canal is relatively
larger in youth than in adult age. Umbilical hernia is
almost entirely a disease of early infancy.

QueteletJ has shown that one-tenth of all the children
born, die during the first month of existence, and that at
the termination of the first year after birth, one-fourth have

* Des Epidemics, etc. Annales d'Hygiene, 1833, tome ix. p. 31.

f Recherches sur la Frequence des Hernies, selon les Sexes, les Ages,
et relativement a la Population. Ann. d'Hygiene, 1840, tome xxiv. p. 33.

X A Treatise on Man and the Development of his Faculties. Edin-
burgh, 1842, (English translation.)

96 A TREATISE ON HYGIENE.

died. So great is the mortality that at the fifth year, of
10,000 boys born in towns, but 5738 remain alive. Nearly
one-half have died.

Herrmann* states that in Russia the mortality of infants
is greater than that of all other ages put together.

According to Villerme 22 per cent, of the total number
of deaths occurring in Paris, from 1817 to 1825 inclusive,
were in infants under one year old, and 44*5 per cent, in
children under ten years of age.

Malletf states that in Geneva, from 1814 to 1833 inclu-
sive, 151 per 1000 of deaths were in children under one
year of age.

Facts are not wanting to the same effect in this country.
The Preliminary Report on the Eighth Census, 1860, pre-
pared by Jos. C. G. Kennedy, Esq., the Superintendent,
gives some very valuable information on the subject of
mortality as influenced by age. From this report we find
that, in the year 1860, 393,606 deaths occurred in the
United States, and that of this number 81,551 were of
children under one year of age, 38,431 between one and
two, 23,715 between two and three, 14,657 between three
and four, 10,498 between four and five, and 27,492 be-
tween five and ten, or a total of 196,344 deaths occurring
in children under ten years of age, very nearly one-half
the whole number.

As the age of the individual advances, the body becomes
more fully developed and is enabled better to resist disease.
By the time puberty is attained, which, in the United
States, is about the sixteenth year for boys, and the fif-
teenth for girls, the tissues have acquired considerable solid-
ity, the bones have become harder — though the epiphyses

* Mortalite des Enfants en Aussie. Annates d'Hygiene, 1830, tome
iv. p. 330.

f Recherches Historiques et Statistiques sur la Population de Geneve.
Ann. d'Hygiene, 1831, toine xvii. p. 5.

AGE. 97

are not yet consolidated to the shafts, and the circulatory,
respiratory, and digestive organs have, in a measure, lost
the excessive sensibility by which they were characterized
in infancy.

The genital organs, which have heretofore exercised but
little influence over the general system, now become capa-
ble of performing their functions. In the male the secre-
tion of semen takes place, and in the female menstruation
commences. The larynx, which in the infant is small and
round, now becomes lengthened, and in the male especially,
the voice assumes a more grave tone.

The intellectual faculties have not been behindhand.
The brain, though relatively smaller, has undergone con-
solidation and hardening of its substance, and has, in con-
junction with the other portions of the system, lost, to a
material extent, the peculiar sensibility to external impres-
sions which belonged to it in early infancy, gaining in
strength, in force, and in capacity for improvement.

The relation between the formative and destructive pro-
cesses is more nearly balanced, and the body has nearly
attained the period when growth ceases. This point is in
males about the twenty-fifth year, and in females a year or
two earlier.

The diseases to which the human subject is especially
liable during the period extending from puberty to matu-
rity, are those of the respiratory organs, and others depend-
ing upon the presence of the strumous diathesis, which at
this time loses the comparative latency which has charac-
terized it and becomes active. From this cause, phthisis,
scrofulous enlargement of the lymphatic glands of the
neck, and tuberculous inflammation of the joints, are
more active at this period than at any other time of life.

Individuals who are about reaching the close of the
period of growth are those who, as has been pointed
out, are less fitted for the military service, and we have

98 A TREATISE ON HYGIENE.

already considered at length the evils, both to the army
and the individual, which result from accepting those who,
for want of sufficient development, are unfit for the very
arduous life which awaits them in the field.

The Period of Maturity. — Some authors consider that
physiologically there are but two periods in the life of
man, that of increase and that of decline. Strictly speak-
ing, this view may be the correct one ; but there is a time
when, if there is any increase in development, it is scarcely
perceptible, and if any decline, this is so gradually effected
that it is inappreciable by any means at our disposal.

This period may very properly, therefore, be regarded
as that at which the formation and decay of tissue are so
nearly balanced that the body may be considered as fully
mature. Tissue is not, as in the preceding stage, deposited
faster than it is removed, but the wants of the system are
exactly compensated by the deposit of new material to
take the place of that removed as effete.

At the commencement of this period, which ordinarily
extends from the twenty-fifth to the thirty-fifth year of
life, the epiphyses of the bones become firmly incorpo-
rated with the shafts. The flesh becomes hard, firm,
and the physical strength is at its maximum. Quetelet,*
whose observations have already been referred to, ascer-
tained that the tractile force is greatest at the age of
twenty-five, and the manual force at thirty.

The mental faculties, though more strongly developed
than in the former period, are not yet at their prime.
This is a curious circumstance, and one which is at
variance with our preconceived opinions. The influence
of the body over the ordinary operations of the mind is
well marked. If the physical health is good, the mind,
other things being equal, is clearer; but, with reference to

* Treatise on Man, pp. 68, 69.

AGE. 99

its maximum power, we find that this is not ordinarily
attained till the physical powers have commenced to
decline.

The diseases which are most frequently met with during
the period of maturity are phthisis and those connected
with the organs of digestion.

A most interesting question is that relating to the cessa-
tion of the growth of the body. Why, after having at-
tained a certain height and weight, should growth stop?
Why do the causes which have been instrumental in de-
veloping the several organs and parts cease to exert any
longer this developing power, but continue merely to pre-
serve them at a certain fixed point, eventually losing even
this power? The views of a distinguished physiologist
(Dr. Carpenter) on this point, as expressed in the follow-
ing observations, are so appropriate, raise so many import-
ant inquiries, and are dictated in so scientific a spirit, that
they cannot fail to engage the attention of the reader, and
excite reflection, if not inquiry, in connection with the
serious problem involved.

" Having thus briefly traced the changes that precede
maturity, we may ask what is that prevents the processes
of growth from advancing at the same rate as they have
hitherto done ? Why, so long as they are undisturbed by
disease or unnatural circumstances, should they not ad-
vance ad infinitum, or at least why should they not raise
man to the strength and dimensions which poets have
fabled in their Titans ? The same food, the same atmos-
phere, the same light and heat, the same electric agencies
by which the organs have been maintained or excited, are
still around them and exerting their influence. Why,
then, should they never transcend a certain point ? Why
should the stature, however much it may vary between a
Boruwlaski and an O'Brien, yet never rise above a certain
measure? Why does the strength never exceed the powers

100

A TREATISE ON HYGIENE.

of a Milo or a Desaguliers, or the intellect surpass the
limits of Aristotle, Shakspeare, or Newton? These are
interesting but impossible problems. If we say that a cer-
in quantum of vital power is allowed to the growth of
man, and that while a portion is expended in raising him
to maturity, the residue must be husbanded for conducting
him through the remaining portion of his duration, else he
might suddenly stop short in his career without passing
those stages that prepare him for the cessation of his
existence, what do we gain by such an explanation?
Nothing; for the term vital power which we employ, is
but a hypothetical cause, or, if more closely examined, is
scarcely even this; it is but an abstract term applicable to
a number of actions that do not occur in the inorganic
world. The vital power of a body is but the collective
manifestation of its vital actions, and to say therefore
that only a certain quantum of vital power is inherent in
it, is but to express in other words the simple fact that
these actions are circumscribed. Discarding this explana-
tion, shall we say that the fact must be referred to some
deficiency in the media of the being's existence; that
although the aliment, the air, the light and caloric are
competent to the production of a certain degree of growth,
they cannot extend it, and that, were their conditions dif-
ferent, the animal development would be more perfect. It
is easy perhaps to suppose this, but we do not see how it
can be proved, nor indeed that existing analogies favor it.
On the surface of our globe there is every variety in the
temperature, in the humidity, and in the electric condi-
tions of the atmosphere, and every diversity in the articles
of food employed; in more limited spheres there are the
greatest diversities in these several respects, produced arti-
ficially by the various occupations of mankind; and,
although we find, both among races and individuals, great
varieties of development, which may occasionally be traced

AGE. 101

to some relation with the media in which they live, these
varieties are by no means in proportion to the differences
of the media, and in the majority of cases the former are
independent of the latter. In the temperate zone, with a
due proportion of animal and vegetable diet, man appears
to attain his most perfect development, and with however
much skill he adapts these circumstances, he never sur-
passes a certain point, and, from what we know of his phys-
iology, no great alteration in any one of the external stimuli
of his existence could be tolerated. A different proportion
of the oxygen, nitrogen, and carbon of the atmosphere
we know full well to be noxious ; a larger or smaller quan-
tity of aqueous vapor suspended in it will occasion many
well-known maladies : the same may be said of alterations
in the balance of electricity that surrounds us. Great ex-
tremes of heat and cold may be borne for awhile, but it is
obvious that they are not so well adapted to a healthy
state of the system, and therefore to its growth, as inter-
mediate degrees ; and consequently it is not easy to con-
ceive any degree either above or below these limits, con-
sistent even with existence. Familiar enough also are we
with the effects of full and sparing, of simple and mixed
dietetics, and with the fact that between certain well-
known bounds lie the salutary quantities and qualities.
From all which it appears sufficiently evident, that we
cannot conceive any difference in the amount or properties
of the known stimuli of life, that would be more favorable
to the growth of man, than those which are to be found
in the range of the known variations, whether natural or
artificial. From the beginning there must have been
established a direct relation between the organization of
the body and the outward elements ; the latter are nothing
but stimulants adapted to coexisting susceptibilities, or to
put it more closely, man is not made by, but for or with,
the surrounding agents; his lungs are fashioned in corre-

102 A TREATISE ON HYGIENE.

spondence with the atmosphere which he breathes, his
digestive organs with the food which is spread so plen-
teously before him, and his nervous system to the subtle
imponderable agents that play around him ; consequently
as his organs only act in concert with, and do not result
from, the media of his existence, a development beyond
that which he is known to acquire must proceed quite as
much from the former as from the latter ; and the suppo-
sition, the value of which we have been endeavoring to
estimate, thus falls to the ground. If man could become a
larger, more powerful, or more sagacious animal than he
now is, he must not only live in different media, but must
possess a different constitution ; in other words, the char-
acters that distinguish him as a species must be altered.
The question, then, that offered itself remains to our
apprehension unsolved by either of the hypotheses. The
limitation of man's development is like the definite period
of his duration, and a hundred other circumstances con-
nected with his existence, an ultimate fact ; no event that
we are able to discover intervenes between its production
and the will of the Deity."*

So far as the foregoing remarks are applicable to the
body of man, they seem to be eminently just. The limita-
tion of his development in this direction is an ultimate
fact which we can no more deny or explain than we can
the existence of a principle which we call gravitation.
We know that the human body is no taller or heavier now
than it was thousands of years ago, that the heart beats
just as often, that the liver secretes just as much bile, that
the muscular strength is no greater. We accept it then as
a law of our being that development is to go so far and no
farther. That is all we know about the subject. But so
far as the observations quoted refer to the mind of man, I

* Cyclopedia of Anatomy and Physiology, vol. i. article Age.

AGE. 103

deny their application. With an eminent physiologist of
this country I too may say that my faith in the intel-
lectual capacity of man is supreme. We know that since
his creation his mind has undergone, and is still under-
going, progressive development, so that it is more ad-
vanced to-day than at any former period in the history of
the world, and will be more expanded to-morrow than it
is to-day. Judging then by what has passed, I dare not
fix a limit to the development of the human intellect. On
the contrary, I believe, most religiously, that though there
are many things which we do not now comprehend, or only
dimly perceive, the time will come when everything which
the Creator has done for us, or the world in which we live,
will be made perfectly clear to our understanding. This
does not necessarily require an increase in the size or
weight of the brain above that now possessed by that
organ, for the mind has no definitive or constant relation
to the matter of which it appears to be the resultant

The Period of Decline. — The period of decline is
marked by as striking characteristics as those which be-
long to the period of increase. After the body has re-
mained at nearly a fixed point of development for a few
years, varying from five to ten, a disposition is manifested
to degeneration. The process of decay becomes more
powerful than that concerned in the regeneration of tis-
sues, and in consequence the body not only loses weight
from the atrophy of its parts, but the functions are less
perfectly performed. Thus the action of the heart be-
comes weaker and less frequent; the respiration slower;
the digestion weaker; the muscles thinner; the skin
shrunken; the joints stiff; the teeth fall out; the hair be-
comes gray; the arteries become ossified; and the entire
form loses its elasticity and becomes less erect than in
adult age. The whole tendency of the body is to consoli-
dation. & The generative function is altogether lost in both
sexes, and in the female the menses cease to flow.

104 A TREATISE ON HYGIENE.

The organs of special sense also become affected. The
eye loses its brightness, and the sight grows dim and pres-
byopic; the taste is less acute, and the sense of smell is
almost, if not altogether, lost at a comparatively early
period.

With these changes the mind also participates. The
memory is the first faculty to fail, and the others follow in
rapid succession.

If these alterations are gradual and uniform through-
out the system, death from old age is the result; but it
rarely happens that derangement of some one important
function does not produce this result before the general
breaking up of the vital principle occurs.

During the first ten or fifteen years, the decay of the
organism is so slowly effected that very little inconveni-
ence results, and occasionally we meet with individuals
who are able to withstand the tendency to degeneration to
a very advanced period of existence ; but it is nevertheless
progressing, imperceptibly it may be, but surely, to the
extinction of that mysterious principle we call life.

Such is a brief outline of some of the conditions which
attend the period of decline. The diseases to which it is
especially liable are those which are related to the princi-
pal organs of life: apoplexy, paralysis, organic diseases of
the heart and lungs, of the large vessels, of the liver and
urinary apparatus, are frequently encountered. The pre-
disposition to malignant diseases is greater during this
period than at any other, especially in the female sex, in
which also a critical period occurs from the cessation of
the menstrual function, during which the procreative
organs are extremely liable to disease. Chronic rheuma-
tism is also very common.

Individuals who have reached the period of decline are
not well suited for the military service. The fatigues in-
cident to the profession of the soldier are such as they can

AGE. 105

ill bear. During the first portion of it, say from thirty-
five to forty years of age, these remarks can scarcely be
regarded as applicable, because, as has been observed, the
regression of the organism takes place at a very slow rate,
and produces no very striking effects; but at a later time of
life they cannot be too strongly insisted upon, for when
the system has lost its elasticity and the power of recu-
peration which distinguished it in youth and adult age, it
has parted with two of the best qualifications which should
belong to the soldier.

Moreover, individuals who have entered the period of
decline become so subject to catarrhal and rheumatic affec-
tions upon the least exposure, that it frequently happens
that they spend more of their time in hospital than in the
ranks of their regiments. An examination of any military
hospital will prove the truth of this assertion. It will in-
variably be found that the greater number of patients
affected with bronchial diseases, with lumbago, stiffness
and pain of the joints, and with those obscure muscular
pains of which we know so little, are individuals who
have passed their fortieth year.

Mentally also they are not the best subjects from which
to select soldiers. Their habits of life are formed, and it is
with difficulty that they are brought under the discipline
which is necessary. Moreover when far advanced in years
they have lost the hopeful and determined character which
is so essential an element in the making of a good soldier.
We have considered the question, Why does the body,
after reaching a certain point of development, cease grow-
ing? A still more interesting one is, Why does the body,
after reaching maturity, begin to degenerate? It is impos-
sible for us to answer this question definitely, and yet we
are not entirely without light on the subject. We know
that by care, and by attention to hygienic rules, we can very
materially prolong life. We know that in consequence

106 A TREATISE ON" HYGIENE.

of improvements in the sanitary condition of man the
average duration of life has been lengthened several years
within the last three or four centuries. Is there not reason
to believe that if we studied the laws of our being more
closely we could still further prolong our existence ? And
if we had a perfect knowledge of the laws of health there
would be, as we have said, no physiological reason why
decay and death should take place except through acci-
dental causes. This view may appear to be a visionary
one, but it is nevertheless logical, and we think correct.

First of all, we want an enlightened system of dietetics.
We want to be able to determine a priori what substances
are necessary to repair a certain amount of waste of tis-
sue and no more. This is of itself a most difficult point,
but one by no means impossible of attainment. A long
series of investigations in regard to tissue metamorphosis
is essential before we can even make a beginning in this
direction, but from what has already been done we may
well be encouraged to hope for more perfect results than
have yet been reached. Now all is darkness — we eat
without regard to the wants of the system, and sooner or
later disorganization ensues. In all inorganic machines
we use those substances for the generation of force which
are proper, and no more of them than is absolutely neces-
sary ; but with the human system no attention is paid to
these points.

Next, we want to be able to exercise all the organs of
the body to that extent only which will insure their ac-
tivity, and the deposit of sufficient new material to keep
them in a good state of renovation, without leading to
excess of either the process of regressive or progressive
metamorphosis.

Finally, the proper use of the mind is to be learned.
The reaction of the intellectual processes upon the matter
of which the body is composed, though sufficiently appar-

sex. 107

ent, is by no means understood, and hence there is a most
important influence at work, which acts unceasingly in
producing decay of the tissues. In a paper which I pub-
lished several years since I showed, by experiments insti-
tuted upon myself, that increased mental exertion was in-
variably accompanied by an increased elimination of urea,
a fact which sufficiently demonstrates the influence of the
mind over the process of tissue decay * We know, too, how
much, nearly all the functions of the body are influenced
by mental emotion of one kind or another.

Through the neglect then of laws which we do under-
stand, and from our ignorance of others which certainly
exist, death, if not hastened by accident or disease, takes
place surely by old age. The process is a gradual one.
The functions cease to be performed from inadequacy of
the organs, and the vital principle, or whatever else we
choose to call it, becomes extinct.

CHAPTER VI.

SEX.

At birth and for some years afterward the differences
which exist between the sexes are scarcely noticeable, ex-
cept so far as different conformation of the genital appara-
tus is concerned. After puberty other evidences of distinct
organization appear, and the several peculiarities which
mark the sexes become manifest. In the male the voice
becomes rough; the penis and testicles enlarge; sperma-
tozoids appear in the seminal liquor; the chest becomes

* See also Physiological Memoirs, p. 21.

108 A TREATISE ON HYGIENE.

broader and deeper ; and hair makes its appearance on the
face, the axillae, and pubes.

In the female the pelvis enlarges, as do also all the
organs of generation ; the function of menstruation, which
consists in the periodical discharge of an ovum, accom-
panied with a flow of blood from the uterus, commences ;
and hair grows upon the axillae and pubes. In a short
time each sex has fully assumed all the characteristics
which belong to it, both mental and physical, so that an
observer is enabled by a casual inspection to determine at
once the sex of the individual. In early childhood these
differences are so slight that without an examination of
the genital organs it is often impossible to make the dis-
crimination in question.

Besides these differences there are others of a more gen-
eral character. The male is stronger, more compactly and
coarsely built; his features are more marked and promi-
nent ; his muscles are more developed ; his bones are
larger ; his whole frame taller and broader. In addition,
his nervous system is not so delicately organized.

On the other hand, the female is more delicately and
finely organized. Her skin is softer; her features smaller;
her muscular system less powerfully developed; her cir-
culation more feeble; and her figure shorter and more
slender.

Sex exercises a very considerable influence over mor-
tality. The number of male children born dead is much
greater than of female children. In the four years from
1827 to 1830 there were 2597 still-born children in
Western Flanders, 1517 of whom were males and 1080
females. In the United States, in 1860, there were 1617
still-born children, of whom 926 were males and 691
females. The mortality is also greater among males im-
mediately after birth. During the two first months after
birth, the ratio is 4 males to 3 females ; during the third,

SEX.

109

fourth, and fifth months 3 to 4 ; and after the eighth or
tenth month a difference scarcely exists.*

The following table, from Quetelet, shows the relative
mortality of the sexes for different ages : —

Age.

Male deaths to one female
death.

City.
1-33
1-33
1-37
1-22
1-24
106
1-06
1-00
0-90
0-82
0-98
1-24
100
0-88
102
1-07
0-96
0-77
0-68

Country.
1-70
1-37
1-20
1-21
116
1-03
0-97
0-94
0-93
0-75
0-92
111
0-86
63
083
1-18
1-05
100
0-92

" 1 " 2 "

« 2 " 3 "

« 6 " 12 "

« 2 " 5 "

« 5 " 14 "

" 18 " 21 "

Thus it is seen that from the period of birth to the age
of two years the mortality among males is greater than
among females. From that time, through the period of
puberty, to the age of twenty-one, the mortality is greater
among females; but from twenty-one to twenty-six, deaths
again predominate among the males. During the child-
bearing period the mortality continues greater with females,
as it does also in advanced old age.

The number of males born exceeds the females. From
more than fourteen and a half millions of observations
made in France, from 1817 to 1831, it was ascertained that
the males were in the proportion of 106'38 to 100. The
proportion in other countries of Europe is shown in the
following table : —

* Quetelet, op. cit. p. 29 et seq.
8

110 A TREATISE ON HYGIENE.

Males to
States and provinces. 100 females.

Russia 108-91

Milan 101 '

Mecklenberg 10*'

Belgium and Holland 106*

Brandenberg and Pomerania 106'

Kingdom of Two Sicilies 106-

Austrian Monarchy 106"

Silesia and Saxony 106-

Prussian States 105*

Westphalia and Grand Duchy of the Rhine 105

Kingdom of Wurtemberg 105 -

Eastern Prussia and Duchy of Posen 105-

Kingdom of Bohemia 105"

Great Britain 104-

Sweden 104-

Gl
Of

44
27
18
10
05
94
86
69
66
38
75
62

Average for Europe 106"

In the United States the number of males very sensibly
exceeds the females. In a recent work* on the subject of
population and other statistics of the United States it is
stated that —

" The excess of male population in the United States,
compared with that of the other sex, presents a marked
difference with respect to other countries. While in the
United States and Territories there is an excess of about
730,000 males in more than 31,000,000 of people, the
females of the United Kingdom of Great Britain and Ire-
land outnumber the males some 879,000 in a population of
little more than 29,000,000. This disparity is the result
of many causes. The emigration from the mother country
of men in the prime of life, and the large demands of their
military, naval, and marine services seem to account for
some proportion of the excess of females; while immigra-
tion from all parts of Europe, our small military and naval

* Preliminary Report on the Eighth Census, 1860, by Jos. C. G.
Kennedy, Superintendent.

SEX. Ill

service, and the few losses we have sustained from the
contingencies incident to a state of war, have served to
exhibit a larger male population in proportion than can be
shown in any country on the globe.

" The great excess of males in newly-settled territories
illustrates the influence of emigration in affecting a dis-
parity of the sexes. The males of California outnumber
the females near 67,000, or about one-fifth of the popula-
tion. In Illinois the excess of males amounts to about
92,000, or one-twelfth of the entire population. In Mas-
sachusetts the females outnumber the males some 37,600;
Michigan shows near 40,000 excess of males; Texas
36,000; Wisconsin 43,000. In Colorado the males are as
twenty to one female. In Utah the numbers are nearly
equal; and while in New York there is a small pre-
ponderance of females, the males are more numerous in
Pennsylvania."

M. Quetelet has made a great many interesting obser-
vations relative to the differences between the sexes in
height, weight, rate of growth, strength, etc., all of which
show the preponderance to be in favor of the male.

The function of generation is that, however, which pro-
duces the greatest difference between the male and the
female, not only in organization and in the character of
the diseases to which they are respectively liable, but also
by reflexion on the mental constitution.

The diseases therefore to which each sex is specially
liable are mainly those which are directly connected with
the generative organs. These in the male consist of affec-
tions of the testicles, the prostate, and the penis. In the
female they are of a much more varied character, because
the genital apparatus is not only more complex but the
functions involved are more multiform, relating to the ex-
ternal organs of generation, the uterus, the ovaries, and
the mammary glands.

112 A TREATISE ON HYGIENE.

Among the most important derangements of the normal
condition to which the female is peculiarly subject, are
those which relate to the menstrual function. The period
at which this function commences varies acording to cli-
mate, being earlier in tropical and warm regions than in
those of low temperature. In this country it usually
occurs at about the fifteenth year, sometimes a year sooner
and occasionally a year or two later. Having commenced,
a periodical discharge, consisting of a sanguinolent fluid,
takes place every four weeks till about the age of forty-five,
when it ceases. It is unnecessary here to enter into the
physiology of the subject. It is sufficient to state that the
bloody fluid comes from the lining membrane of the uterus,
and that an ovum is discharged with it. With the occur-
rence of pregnancy this periodical discharge is interrupted,
and it frequently remains suspended during lactation.

The commencement of menstruation and its cessation
constitute critical periods in the life of the female, and
exert a great influence upon her health and mortality.

The first discharge is accompanied ordinarily by a
variety of abnormal circumstances, such as headache,
fever, nervous derangement, pain in the loins and uterus,
etc., and even the subsequent returns are often thus at-
tended. If any tendency to tubercular disease of the
lungs exists it is exceedingly liable to become developed
about the time of the first menstruation. It is mainly
owing to this fact that the mortality is so greatly increased
among females at the period in question.

The function in those who are healthy in this respect
continues about thirty years, when it becomes more or less
irregular, and finally ceases altogether. In some women it
is very irregularly performed from the first, and this de-
rangement, when it exists, is a fruitful source of the great
variety of nervous and debilitated conditions by which so
many females of modern society suffer. Perhaps it is not

SEX. 113

saying too much to express the opinion, which I am sure
is well founded, that there is scarcely a woman belonging
to the upper classes of society who is not more or less ir-
regular in her menstrual discharges, and this, too, from
causes which are the result entirely of an artificial and ab-
normal mode of existence. Exposure to cold and damp
when thinly clad or shod, late hours in exciting society,
the reading of modern works of fiction, thereby exciting
the imagination or feelings of a sensitive girl, influence ma-
terially the condition of the generative organs, with respect
principally to the amount of blood flowing to them, and
perhaps above all inhaling the atmosphere of badly venti-
lated and excessively heated rooms. Irregularity, whether
in the quantity of the menstrual discharge or the period-
icity of its occurrence, when once inaugurated is very apt to
become constant. Congestion of the womb or of its neck
is thus produced, and inflammation or ulceration follows.

The period of cessation of the menses is also one which
is often marked by the irruption of some latent tendency
to disease. Malignant affections of the uterus or mam-
mary gland almost altogether select this period for their
appearance, and at this time we find the rate of mortality
again increased.

Gall contended that there was a periodical manifesta-
tion in men analogous to that existing in females, though
of course different from it, and Levy* holds a similar
opinion ; the latter states that " young and robust persons
do not notice this tendency unless their attention is par-
ticularly directed to it; but men feebly constituted, or
fatigued by recent hardships, or endowed with a great de-
gree of irritability, or who have reached the period of
their decline, perceive the alteration which their health
monthly undergoes : their countenance becomes dull ;

* Traite d'Hygiene, tome i. p. 122.

114 I A TREATISE ON HYGIENE.

their perspiration assumes a stronger odor ; their digestion
is more laborious, and sometimes the urine deposits a
heavy sediment. The feeling of discomfort is general and
inexpressible, and the mind participates in it, for it is more
difficult to maintain a train of ideas ; a tendency to melan-
choly, perhaps an unusual irascibility, are joined to the
indolence of the intellectual faculties. These modifica-
tions persist some days and disappear of themselves."

I have certainly noticed in many of my friends this
tendency to some monthly periodical abnormal manifesta-
tions. This may be in the form of a headache, or a nasal
hemorrhage, or a diarrhoea, or an abundant discharge of
uric acid, or some other unusual occurrence. I think this
is much more common than is ordinarily supposed, and
that careful examination or inquiry will generally, if not
invariably, establish the existence of a periodicity of the
character referred to.

During pregnancy the female is also subject to altera-
tions of the normal course of life. These are in the form
of headache, vertigo, neuralgia, palpitation of the heart,
heartburn, nausea, vomiting, etc., besides a large number
of what might more properly be regarded as disagreeable
or uncomfortable conditions rather than positive diseases.
Puerperal mania, puerperal convulsions, and puerperal
fever, are of a far more serious character, as are likewise
many of the accidents which attend labor.

During lactation the system of the female is severely
taxed, and as a consequence emaciation often ensues. Be-
sides, the mammary glands become subject to inflammation
and abscess.

It is thus seen that from the commencement of men-
struation to the termination of this function the female is
liable to a peculiar class of diseases and accidents, which
materially add to her rate of sickness and mortality.

Digestion is less active in the female than in the male,

HEREDITARY TENDENCY. 115

the consequence of deficient muscular power in the stomach
and intestines. Women, therefore, rarely indulge with im-
punity in articles of food requiring strong digestive power,
but should prefer milk, eggs, tender meat, and light ali-
mentary substances. They are more frequently sufferers
from dyspepsia than men.

Diseases of the brain are much more common with men
than with women. This fact is due to the greater activity
of their lives, producing anxiety and excitement. For the
same reason diseases of the circulatory system are also
more frequently met with among males.

Those diseases which are more or less produced by ex-
posure to inclement weather or hardships, or which are
the result of bad habits, are more frequently met with
among men than women. Pneumonia, pleurisy, bron-
chitis, rheumatism, dysentery, diarrhoea, typhoid fever,
coup de soleil, delirium tremens, syphilis, and many others,
belong to this class.

On the other hand, phthisis, cancer, dropsy, chorea, and
several others due to weak or deformed organization, or to
irritability of the nervous system, are more common with
females than males.

CHAPTER VII.

HEREDITARY TENDENCY.

The hereditary transmission of peculiarities of form, in-
tellectual character, manner, and proclivity to disease, is
no longer a subject of doubt by those best qualified to
judge in the matter. In fact, to this tendency of like to
beget like, we owe the perpetuation of the different species
of animals and plants, as well as the great number of

116 A TREATISE OJS T HYGIENE.

varieties which are produced by the will of man or acci-
dental causes.

We see on every side numerous instances of the exist-
ence of the law referred to. The different varieties of the
dog, of the ox, and other domestic animals, the various
kinds of roses, apples, strawberries, and other plants, are
all the results of hereditary transmission.

Resemblances in features to parents are extremely com-
mon in the progeny. A child looks like its father, its
mother, or perhaps some collateral relative. The heredit-
ary upper lip of the members of the house of Hapsburg is
an example of this, and others must be familiar to most
persons. In the lower animals the same circumstance is
very frequently met with. A whole litter of pups will be
marked like the father or mother, or perhaps some like
one and the balanoe like the other.

Certain qualities can also be transmitted. Thus the
setter and pointer possess their peculiar qualifications by
hereditary descent from ancestors which were taught to
indicate the presence of game by the actions they employ.

Deformities are likewise sometimes indubitably trans-
mitted to the progeny. It is by no means rare to find
that the immediate ancestors of individuals with super-
fluous fingers or toes, club-feet, or hare-lip, were also the
subjects of these malformations.

In regard to the intellectual cast of the mind there has
been more difference of opinion, though we think there
cannot be much doubt on the subject. Mr. Buckle, in his
classical History of Civilization in England, denies that
any tendency exists to the transmission of the qualities of
the mind. He says : —

"We often hear of hereditary talents, hereditary vices,
and hereditary virtues; but whoever will critically ex-
amine the evidence will find that we have no proof of
their existence. The way in which they are commonly

HEREDITARY TENDENCY. 117

proved is in the highest degree illogical, the usual course
being for writers to collect instances of some mental pecu-
liarity found in a parent and in his child, and then to
infer that the peculiarity was bequeathed. By this mode
of reasoning we might demonstrate any proposition, since
in all large fields of inquiry there are a sufficient number
of empirical coincidences to make a plausible case in favor
of whatever view a man chooses to advocate."

This view is very unphilosophical, and one which is
opposed to the constant evidence of our senses. If the
parents, or either one of them, can transmit to their
offspring a peculiar form and quality of brain, the psychical
attributes of that brain will also necessarily be transmitted.
We are not to forget, however, that education plays a very
important part in the matter, and that a child born with a
tendency to some virtue, vice, or intellectual trait, may
have this tendency entirely overcome, or at least ma-
terially modified, by education. Perhaps the most strik-
ing instances of hereditary influence are exhibited by
those individuals who show a facility or inaptitude for
appreciating musical notes. It will almost invariably be
found that the ability or inability to acquire a knowledge
of music is derived from the ancestry. I have known
several instances in which both parents could not turn a
tune, or tell one note from another, and in which none of
a numerous progeny could do so either.

But the most important part of the subject of hereditary
influence which we have to consider is in relation to the
transmission of diseases, or predispositions to diseases.
Like the transmission of the physical and mental quali-
ties, the transfer of pathological tendencies from parents
to offspring must be accepted as a fact amply capable of
proof, but not susceptible of explanation. When we say
that the seminal fluid, being derived from the blood, must
possess the peculiar abnormal impress of the blood, we

118 A TREATISE ON HYGIENE.

assert a proposition just as difficult of demonstration, and
in no way an elucidation of the question. Besides, admit-
ting that the seminal fluid of a phthisical person may con-
tain, in an inappreciable form, the germs of tubercles, we
could not explain why the offspring of such a person
should remain all their lives free from phthisis, and the
next generation exhibit unequivocal evidences of tubercu-
lar deposits in the lungs. That the tendency to certain
diseases is derived from the seminal fluid of the male, and
ovaries of the female, scarcely perhaps admits of a reason-
able doubt; but that there are other agencies at work
capable of influencing the child while yet unborn, is quite
as certain. And this fact demands that a distinction shall
be made between those diseases, or other peculiarities,
which are connate, and those which are purely hereditary.
By a connate disease we understand one which the child
possesses when born, not necessarily the result of any simi-
lar taint or impression received from the system of the
father or mother, but due to accidents or mental influence
operating through the mother. For instance, a child may
be born idiotic, not because either of the parents or other
ancestors were thus affected, but from the influence of
some severe mental shock received by the mother during
her pregnancy. Another may be epileptic when neither
parent has ever been subject to epilepsy, if either is in-
toxicated at the time of the intercourse resulting in con-
ception.

Such cases are not due to hereditary transmission, for a
disease cannot be communicated hereditarily which has
not affected either of the parents or their progenitors.

A singular fact connected with the transmission of dis-
eases (and deformities or resemblances) is, that a whole
generation is sometimes passed over, the disease or other
peculiarity appearing in the next. We cannot undertake
to explain this very remarkable circumstance, but we see

HEREDITARY TENDENCY.

119

instances of it continually. A father or mother may be
phthisical, the children exhibit no evidences of the disease,
but the grandchildren die of it; and so of other morbid
affections. Or an individual may exhibit some particular
trait, either of features or mind, which, passing over his
children, appears in the successive generation.

A distinction is also to be made between those diseases
which, though hereditary, are congenital, and those which
appear after a lapse of time often considerable. Thus,
for example, cataract, deafness, and several kinds of de-
formities belong to the first-named class, but the great
majority belong to the second, and arise as a consequence
of the predisposition which has been transmitted. They
are thus of very great importance to the hygieist, because
as the tendency only is transmitted, and this may not
be very strong, it is altogether possible frequently to pre-
vent the predisposition being developed into positive

disease.

A very striking physiological fact is not without influ-
ence upon the laws of hereditary transmission. It is well
known that the children of a woman by her second hus-
band may resemble, physically and mentally, her first hus-
band, provided she has had children by the latter. The
blood of the foetus in utero circulates through the system
of the mother. This blood has the impress of the father
derived through the seminal fluid. It must, therefore, in
a greater or less degree, exert an influence upon the organ-
ism of the mother. We know this from several facts
which will be considered more at length hereafter. Now
the husband dying, and the mother marrying again and
having children, is the medium of transmitting to this
second set of offspring the peculiarities which she has re-
ceived from her first husband through his children. In
this manner the diseases of a man may be transmitted to
children which are not his. In the lower animals in-

120 A TREATISE ON HYGIENE.

stances of this species of transmission are far from rare.
A bitch will have a litter, one-half of which will resemble,
in their markings, their progenitor, and the other half a
dog bv which she has previously had offspring. In the
horse the same fact is also often noticed, and doubtless
prevails, to some extent, throughout the entire animal
kingdom.

The whole subject of the hereditary transmission of dis-
eases is one of very great interest and importance, and de-
serves much more careful study than it has yet received.
When we understand the laws by which it is governed, we
shall have accomplished much toward alleviating a great
portion of the suffering to which mankind is liable.*

Phthisis is, of all diseases, that which is most frequently
encountered as the result of an inherited predisposition.
So generally is this its origin that some authors doubt that
it is ever originally produced in an individual. Though
this opinion is not correct, the fact that it is held by emi-
nent authorities is of itself a strong proof of the great
predominance of phthisis by hereditary transmission.

Occasionally it happens that tubercles exist in the infant
at birth, but generally this is not the case. Even should
they be present at this early period they do not soften
until some exciting cause arises, and this event may not
take place for several years, and by care and the adoption
of proper measures may be altogether prevented.

In the great majority of cases the predisposition to
phthisis which may have been inherited, remains dor-
mant in the system till about the age of puberty or later.

I have very little doubt in regard to the capability of

* The Traite Philosophique et Physiologique de l'Heredite Naturelle,
etc., by Dr. F. Lucas, is the best work extant on the subject. Though
containing many ideas which at present appear to be absurd, it abounds
in much earnest and sincere thought.

HEREDITARY TENDENCY. 121

altogether arresting the development of the tubercular dia-
thesis. The use of a diet of which animal food forms the
larger portion, habitual and systematic exercise, and warm
comfortable clothing, together with a residence, during the
inclement seasons of the year, in a mild and equable cli-
mate, will often prove entirely sufficient to prevent the
predisposition from becoming active.

Gout is another hereditary disease, the liability to which
may be much lessened by proper hygienic proceedings,
such as attention to the diet, which should be plain but
nutritious, systematic bodily exercise, and residence in a
salubrious climate.

Apoplexy and organic diseases of the heart, which are
also often due to hereditary influence, may be prevented
in many instances by the employment of similar measures,
and by the avoidance of strong mental emotions and severe
intellectual labor. Insanity and epilepsy are also more or
less under the control of preventive means.

On the other hand, there are several pathological affec-
tions which, frequently the result of hereditary tendency,
are not capable of being prevented by any means within
our knowledge. To this class belong idiocy, cancer,
syphilis, and several others.

When there is reason to believe that an individual pos-
sesses a hereditary predisposition to any disease, it is the
duty of the medical adviser to study the constitution of
his patient thoroughly, in order that he may be better
qualified to recommend such measures as are most capable
of preventing the manifestation of the threatened disorder.
In general terms, these means are such as reason and ex-
perience have shown to be most effectual in maintaining
the system in a healthy condition under ordinary circum-
stances. Pure air, light, sufficient clothing, and good
nutritious food, conjoined with a due amount of bodily
exercise, and, as far as possible, the maintenance of an

122 A TREATISE ON HYGIENE.

equable frame of mind, are the agents mainly to be relied
upon. Some diseases require, in addition, special measures
of prevention. The limits of this work will not, however,
admit of a detailed consideration of these, or indeed of
further discussion of the interesting subject of hereditary
tendency.

CHAPTER VIII.

HABIT.

When a living being performs an act under the opera-
tion of certain impressions which are received, there is a
tendency toward the performance of a similar act if like
influences are brought to bear upon the organism. Every
time the act is performed the disposition to repeat it be-
comes stronger, until at last the habit is so firmly estab-
lished that the act is accomplished without the reception
of impressions similar to those which originally gave rise
to it, but solely through the force of the newly acquired
power.

This disposition to repetition is not limited to physical
acts; it prevails in regard to almost every function of the
body and mind, and forms often an important element in
the production of disease.

Habit, therefore, is periodicity, and may be defined as
the disposition which the organism acquires, from the fre-
quent performance of certain acts, to repeat these acts
until some more powerful force intervenes.

Again, it is well known that the impressions or conse-
quences which result from the action of certain agents

HABIT.

123

become less marked if the operation of the cause is re-
peated. Thus the system becomes habituated to the
action of alcohol, opium, and many other substances, so
that while a small quantity will, in the first instance, pro-
duce the characteristic result, the dose must be larger each
time that it is taken, or more frequently repeated, in order
to be followed by a corresponding effect.

There are many most noxious agents to the action of
which the system may become so habituated that no in-
jurious results follow, when, without the protection thus
afforded, death would certainly be produced.

The influence of habit over the ordinary operations of
the economy is constantly seen ; the sensations of hunger
and thirst are experienced at stated periods of the day, be-
cause by frequently eating or drinking at those times the
system, as it were, expects a repetition, and hence the sen-
sations experienced. The action of the same law is seen
in the regularity with which the desire to evacuate the
bowels recurs at the same hour of the day when by habit
we have become accustomed to the act at that time ; so
with the desire for sleep, the hour of awaking, and the in-
expressible feelings excited by the want of a cigar or a
customary alcoholic stimulant, with many others which
must be familar to every reader.

The manners and customs of nations are mainly the re-
sult of habit, continued through a long succession of gen-
erations. It is as difficult to alter these as it is to change
a long-established habit of the individual organism.

Some persons are more under the influence of habit than
others; they acquire a habit more quickly and lose it with
less facility. So strong are the unpleasant feelings excited
by any interruption in the regular course of their habits
that they will endure the greatest inconveniences to in-
dulge them. I know a gentleman whose custom it was to
touch a certain tree on the road from his house to the rail-

124 A TREATISE ON HYGIENE.

way station, a distance of about five miles, as he daily went
to his place of business. On one occasion, through absence
of mind, he neglected this action, and rode several hundred
yards before he discovered his omission. Though feeling
annoyed, he continued his journey; but the uncomfortable
sensation became too strong for him to endure it longer,
and, after having ridden nearly two miles past the tree, at
the risk of missing the train he galloped back and touched
it as usual.

In explanation of the cause of habit we can bring for-
ward nothing very definite. We know that with inorganic
matter a force once acquired will continue indefinitely if
no more powerful force interferes with it. A ball thrown
into the air would continue in motion but for the influence
exerted by gravity and friction. We can conceive a simi-
lar law to be in operation on organized matter. An im-
pression is made upon the brain, and through the nerv-
ous system certain actions ensue. The impression is not
effaced with the accomplishment of the resultant act; some-
thing of it remains, to be strengthened, perhaps, by a simi-
lar impression made the following day at the same time,
with similar results. This course may continue from day
to day until the impression made upon the brain becomes
strong enough to produce the associated actions without
aid from without, and thus a habit is established.

For instance, a person is induced to smoke a cigar after
dinner. The inducement, whatever it may be, constitutes
the impression made on the brain. The persuasion of a
friend, the desire to be sociable, or an idea that smoking
would prove beneficial to the health, prompts to the act,
and the cigar is smoked. It is repeated for the same
cause, until at last the act of repetition begins to exercise
its effect, and the original incentive is lost sight of in the
more powerful one which has taken its place. The habit
is now fully formed, and cannot be broken without violence

HABIT. 125

to the feelings. The oft-repeated impression has left its
traces each time until at last it assumes a local habitation
and becomes permanently fixed in the brain, not to be lost
unless through some more powerful influence acting in a
similar manner to the first.

A habit may be acquired for a disease, and thus a very
powerful cause of predisposition brought into action. An
attack of pneumonia, for example, leaves the individual
more inclined to another seizure than before, and so with
many other diseases.

The most striking instance of a disease being kept up by
habit is furnished by intermittent fever. There can be no
doubt that after the disease has been fairly established
through the influence of malaria, it is continued often for
several months after removal to a healthy climate by the
force of the habit which has been acquired by the regu-
lar occurrence of the oftrrepeated paroxysm. Indeed, so
strong is the influence of habit in producing the phe-
nomena which, collectively, are known as intermittent
fever, that it is quite possible to produce the disease arti-
ficially as it were.

The very interesting experiment performed by M. Bra-
chet affords us conclusive evidence on this point. This
observer took a bath in the Seine every night at twelve
o'clock toward the end of October, 1822. This was con-
tinued for seven successive nights. After each bath he
went to bed, covered himself warmly, in a short time be-
came very hot, and finally broke out in a copious perspira-
tion. Discontinuing his cold bathing at the expiration of
the seven days, M. Brachetwas very much surprised to find
that, at the hour for taking his bath, he was attacked with
shivering, fever, and perspiration in regular order, and not
to be distinguished from an ordinary attack of ague. For
six successive nights he was thus affected. On the seventh,
about midnight, he was summoned to attend a case of

126 A TREATISE ON HYGIENE.

labor ; the ride heated him, and the heat was continued
by his standing for some time in front of the fire, and thus
the habit was broken up.*

The influence of long-continued bleeding hemorrhoids is
also such as to show the force of habit in a very striking
manner. A certain quantity of blood is lost every day,
and the system thus becomes accustomed to the abnormal
condition. If this state is altered by the removal of the
hemorrhoids giving rise to the loss of blood, hemorrhage
is apt to occur from some other part of the body, or serious
disease is excited.

In the next place, certain bad habits are to be con-
sidered. Many of these exercise a very deleterious influ-
ence over the economy, even if slightly indulged in, while
others are bad more in name than in reality, and only
positively obnoxious when carried to excess. Some are
acquired by the act of the individual, and are more or less
under his control, while others result from causes not sub-
ject to his action. The principal morbid habits to which
man is liable will be considered under their appropriate
heads in the following chapter.

* Watson's Practice of Physic. Am. ed., p. 482.

MORBID HABITS. 127

CHAPTER IX.

MORBID HABITS.

Nervous System. Encephalon. — There are several con-
ditions of the system, the result of habitual thought in
certain fixed directions, which can be more appropriately
considered as morbid habits of the encephalon than under
any other head.

Nostalgia is one of these, and is of peculiar importance
in its relations to the military service. The derivation of
the word — v6<tto<;, a return home, and aXyoq, pain — suffi-
ciently indicates its meaning.

Although there is ordinarily in an active campaign suffi-
cient diversion for the mind, of such a character that it is
impossible for the soldier to fix his thoughts for any great
length of time on home and its associations, when winter
comes, and it is impracticable to continue operations, or
when garrisoning posts where but little variety marks the
days as they drag slowly along, the mind of the soldier
who has a home instinctively turns to the fireside he has
left. Imagination pictures to him the events which are
there transpiring ; at night he dreams of them, awaking in
the morning to pass another weary day in pining for the
companionship of those he loves, and for the # scenes amid
which he was born. The continuation of such emotions
eventually produces a diseased condition of the mind, and,
by sympathy, disorder in the functional operations of the
organism. The most prominent symptom is a general
emaciation from want of appetite and defect in the powers
of digestion and assimilation. This is conjoined with an
excessively depressed state of mind, during which nothing
diverts the thoughts from home and its remembrances.

128 A TREATISE ON HYGIENE.

The music of some familiar song aggravates the deplorable
condition. So strong is the influence of music that it has
often been found necessary to prohibit the regimental bands
from playing airs which could recall or freshen the memories
of home. At length, if relief be not afforded, fever appears,
and the patient gradually sinks and dies of sheer exhaustion.

The viscera, which are secondarily affected, are mainly
those of the abdominal cavity. Thus the appetite dis-
appears from want of tone in the stomach, and the concen-
tration of the thoughts on a more engrossing subject; there
may be vomiting, diarrhoea, palpitation of the heart, and
sometimes convulsions and delirium.

M. Laugier* reports a case of nostalgia in which, after
death, the cerebellum was found disorganized, and M. De-
vaux-j- details a similar case, in which, among other evidences
of organic disease of the brain, a hydatid was found in the
right lateral ventricle. The first-named writer appears to
think the lesion the consequence of the nostalgia, while
M. Devaux holds the reverse view. The latter is most
probably correct, as we know that disease of the brain will
give rise to abnormal ideas, and there is no reason why an
abnormal desire to be at home might not also be thus
excited. PinelJ regards nostalgia as a form of melan-
cholia, in which opinion he is undoubtedly correct.

Some nations afford more examples of nostalgia than
others. As a general rule the more mountainous and wild
the country the more prone are the natives to nostalgia
when removed from it. The Swiss, the Savoyards, and
the Laplanders are peculiarly the subjects of this affection.
The American Indian also readily dies of grief if separated
from the scenes amid which he has lived. On the con-

* Recueil de Memoires de Medecine, de Chirurgie, et de Pharmacie
Militaires, tome viii. p. 179.

t Recueil de Memoires, etc., tome xi p. 248.

% Nosographie Philosophique, etc., 5eme edition. Paris, 1813, tome
iii. p. 97.

MORBID HABITS. 129

trary, the negro is little liable to mental disorder, even
when forcibly abducted from his home and sold into
slavery. So far as my observation extends, individuals of
the Anglo-Saxon race exhibit little proclivity to nostalgia.
The cause of this immunity is doubtless to be found in
the fact that this race is, above all others, especially the
American branch, the least attached to localities.

Young persons are more subject to nostalgia than indi-
viduals of mature age. In the army this is particularly
the case, almost all the examples of it occurring in soldiers
who have not reached their twenty-first year.

The best means of preventing nostalgia is to provide
occupation both for the mind and the body. Idleness is
the great immediate cause, obviously, for the reason that
time and opportunity are afforded for the indulgence of
the imagination. Thus it is that the affection is apt to
occur among the inmates of the hospitals, especially in
those who are wounded and confined to their beds, though
capable of fully exercising their minds. Soldiers placed in
hospitals near their homes are always more prone to nos-
talgia than those who are inmates of hospitals situated in
the midst of or in the vicinity of the army to which they
belong. In the one case the reminiscences of home are
more powerfully brought before the mind, while in the
other the current of thought is more liable to run in
another direction. Besides, being near one's home is
always a stimulus to the hope of reaching it, which ex-
pectation not being realized the nostalgic condition is de-
veloped; while, when it is certain that under no circum-
stances can a return to one's fireside take place, the mind
accepts the terms so imperatively imposed, and ceases to
hope for what is impossible of attainment.

Baudens,* in alluding to this subject in a letter to the
Minister of War, says:—

* La Guerre de Crimee, p. 36.

130 A TREATISE ON HYGIENE.

* * * " Hospitals for six thousand men, in addition
to the regimental hospitals, would be sufficient for the sick
of the army. The transportation of patients to Constanti-
nople, of so frequent occurrence at present, so injurious to
them, especially in bad weather, and so expensive to the
government, would be far less frequent. The hospitals at
Constantinople, which require to be purified by disuse,
would thus be kept in reserve for secondary use; a por-
tion of the attendants and furniture being sent to the
Crimea. It would be wise to build, near the monastery of
St. George or at Constantinople, a large depot for convales-
cents, for it is of the utmost importance that these emi-
grant fleets should be stopped. The best means of increas-
ing the morale of the troops and of putting an end to the
desire to return home — natural enough, but destructive of
discipline — is to altogether do away with this sending off
of the sick; which, to my mind, has led to great abuses,
since, of one hundred patients sent to Marseilles, but ten
were fit subjects for the hospital."

Similar language might at one time have been justly
used in regard to our own armies, and even now is appli-
cable to some extent. There can be no doubt in regard
to the injurious results of sending men to the vicinity of
their homes. Not only is the desire to be with their
friends greatly increased, and the tendency to nostalgia
augmented, but the military spirit is weakened. Hospitals
should, so far as is possible, be as near the lines of the
army as is compatible with the security of the establish-
ments from the attacks of the enemy.

Hypoclwndria is another affection properly to be alluded
to under the present head. This condition is brought
about by the continued action of the mind upon some one
organ or function which is supposed to be disordered. It
is possible, by this concentration of thought, really to pro-
duce derangement, and even positive disease of the organ

MORBID HABITS. 131

upon which the thoughts are fixed. This is especially the
case as regards the heart. Hypochondria is more frequent
in males than in females, and is almost altogether a disease
of civilization. Men of letters, statesmen, savans, and, in
general terms, educated persons, are more subject to it
than the laboring classes. Many most whimsical cases of
it are to be met with scattered through the literature of
medicine.

It very often is the case that hypochondria is primarily
due to some derangement of the chylopoietic viscera.
When such is the case the efforts of the physician should
be directed to its correction. When there exists a tend-
ency to this affection, the mind should be kept occupied
with matters which will divert the thoughts of the indi-
vidual from himself, and, at the same time, sufficient physi-
cal exercise should be strictly enjoined. Traveling affords
an excellent means of accomplishing these ends. I doubt
if any case of hypochondria could withstand a trip on
horseback to the Rocky Mountains or a pedestrian tour
through Switzerland.

The Special Se?ises. — The organs connected with the
special senses are also liable to contract morbid habits,
which interfere with the complete performance of the
functions belonging to them. The sense of sight is thus
deranged by myopia, presbyopia, and strabismus, all of
which may be produced by habit, or continue through the
influence of this power, long after the cause has ceased.
Persons have been rendered myopic by reading in a bad
light, rendering it necessary to hold the book close to the
eyes. I know of a case in which the affection was pro-
duced by this cause in a single evening. Individuals who
are much in the habit of working at employments requir-
ing them to look at very small objects, are generally more
or less myopic.

On the contrary, persons who are obliged to view distant
objects intently, become presbyopic.

132 A TREATISE ON HYGIENE.

Strabismus is often continued through the force of
habit, and is sometimes produced by it. Children who
are rendered strabismic by the reflex action of an irrita-
tion, excited in the intestinal canal by worms, are rarely
cured without an operation ; the habit established becomes
permanent. Strabismus is also produced and rendered
permanent by the intentional squinting which some per-
sons indulge in, either in imitation of others or through a
bad habit which they have acquired.

It occasionally happens that the sense of smell becomes
altered through the influence of habit, but the instances
are not frequent. The same may be said of the other
special senses.

Circulation. — Palpitation of the heart is often kept up
by habit after having been excited by another cause, such
as mental emotion, the excessive use of alcoholic liquors
or tobacco, full living, venereal excesses, etc. Persons of
nervous temperament are more subject to palpitations than
others; thus they are frequent in weak hysterical females,
especially if there is any disorder of the menstrual func-
tion. Students, especially medical students, are also very
subject to palpitations simulating organic disease of the
heart. Two causes are generally in operation: excessive
mental labor, whereby the digestive and assimilative func-
tions are deranged and irregularity excited in the action of
the heart by sympathy, and the concentration of the
thoughts upon the disorder thus produced. Physical ex-
ercise, the avoidance of late hours, a reduction of the
amount of intellectual exertion, and successful efforts to
divert the thoughts from the heart, will generally suffice
to effect a cure. It has been remarked that in studying
the diseases of the heart medical students are very apt to
imagine their own hearts to be disordered. It is perfectly
possible to produce organic disease of the heart through
the influence of the mind. The fact has been verified
frequently in times of great national excitement.

MORBID HABITS. 133

Epistaxis. — Few persons reach the adult age without
having been subject to nasal hemorrhage in their youth.
It may become habitual, and the attacks of it can scarcely
be arrested without danger to the organism. As the indi-
vidual advances in age the habit is gradually lost.

Hemorrhoids. — The discharge from hemorrhoidal tumors
is also one of those morbid habitual evacuations which
cannot be suddenly arrested without a liability to disease
of some other part of the body. Hemorrhage from the
lungs, apoplexy, and inflammations of important viscera
may be induced by the immediate removal of hemor-
rhoidal tumors, which, by the discharge from them, have
served the organism almost in the capacity of a natural
emunctory. Great care should therefore be exercised in
attempting their cure, and efforts should always be made
to provide some channel, easily under control, through
which the system can act in getting rid of matters which
it has been accustomed to discharge.

An attack of simple hemorrhoids always predisposes to
another. A portion of the blood, which has been collected
to form the tumor in the external pile, always remains in
the sack, and the tone of the vein being, in a measure, lost,
a recurrence is always to be expected. In the internal
form of the disease the vessels, both arteries and veins, are
concerned. The structure of the tumors thus formed is
such that they bleed freely on the slightest touch, or
from any cause which temporarily interferes with the free
circulation of the blood in the hemorrhoidal vessels.

Respiration.— The respiratory organs are the subjects
of certain morbid habits. Bronchitis frequently becomes
habitual, and may exist for years without disturbance to
the general health of the individual. Some children show
a predisposition to be attacked with spasmodic croup. I
have known several in which, at the approach of night,
throughout the whole winter, huskiness of the voice and

134 A TREATISE ON HYGIENE.

the peculiar croupy cough invariably appeared. As they
advanced in years the habit became less marked, and
finally disappeared entirely. Asthma is also often kept up

by habit.

Digestion. — Flatulence is frequently habitual, and
present for a long period without being due to any dis-
ease of the alimentary canal; at other times there is
simply a slight loss of tone in the coats of the intestines.

Besides the air swallowed with the ingesta, the intestinal
gas is derived from the decomposition of the food and
secretions, and is also directly exhaled by the intestinal
mucous membrane. A very considerable portion of the
gas is absorbed again into the system, where it enters into
other combinations; the remainder is expelled from the
body by the mouth or anus. Oxygen, nitrogen, carbonic
acid, hydrogen, carburetted hydrogen, and sulphuretted
hydrogen are the gases which enter into the composition
of the intestinal flatus.

The secretion of gas in the intestines is controlled by
several circumstances. The practice of bolting the food,
sedentary habits, dyspepsia, and intense mental occupa-
tion or anxiety, all give rise to an increase in the quantity
of intestinal gas. By the avoidance of these causes, the
amount formed can be very much reduced. Medicines
exercise but little influence in diminishing the quantity of
flatus; certain stimulant and aromatic substances, by in-
creasing the peristaltic action of the intestines, cause it to
be more readily given off.

Voitiiting. — It appears to be essential to the health of
some persons that the stomach should be regularly
evacuated by vomiting. Levy* quotes from Raymond a
curious case of this kind. "An illustrious and holy pre-
late having been accustomed to vomit every morning be-

* Op. cit., tome i. p. 195.

MORBID HABITS. 135

fore breakfast a watery mucus without taste or color, fol-
lowed by the expulsion of a little yellow and bitter bile,
enjoyed excellent health, but removing to Paris was per-
suaded to abandon the habit. He therefore ceased to
provoke vomiting by means of a feather, with which he
tickled the fauces. He had only given up his habit four
days when he was attacked with a fever, preceded by
chills; this was accompanied by weight and pain in the
head, and was soon followed by a violent delirium. His
valet, who was fortunately acquainted with his peculiarity,
seeing him in this state, did nothing more than to push
the feather down his throat, which act was immediately
followed by the expulsion of the fluid which he was in the
habit of vomiting. By this means the fever, the delirium,
and the pain in the head were immediately caused to dis-
appear. Since then this very worthy and truthful prelate
produces vomiting every morning by means of his feather.
It can be justly said that by this means he has maintained
a perfect state of health and a long life, for he has reached
his eighty-seventh year."

I have myself known several persons who vomited every
morning immediately on rising from bed, and who enjoyed
excellent health. Infants vomit habitually without ex-
periencing any of the disagreeable sensations which ordi-
narily accompany the act in adults. Repletion of the
stomach seems to be the only cause necessary to excite it

in them.

Some few persons have the power of vomiting at will
by a forcible contraction of the abdominal muscles. The
eminent physiologist, M. Brown-Sequard, possesses this

faculty.

Females, from a vicarious excretion of the menstrual dis-
charge, vomit, at the usual period, a dark, grumous, bloody
fluid. This is unaccompanied with derangement of the
health. On the contrary, if this elimination is prevented

136 A TREATISE ON HYGIENE.

in any way, the symptoms attendant on suppression of the
menstrual flow are produced.

Diarrhoea. — Frequent discharges from the bowels may
be perfectly compatible with health in other respects. I
have known several persons who had habitually five or six
fecal evacuations daily, and yet who presented no evidences
of ill health. Every experienced practitioner must have
met with similar cases. Sometimes the stools are thin
and serous, at others of the natural consistency. Strong
peristaltic action of the bowels, and constriction of the ab-
dominal muscles, come on at stated periods which have
become fixed by habit.

It is dangerous to attempt the cure of a diarrhoea which,
through the force of habit, has become firmly established.
A case was not long since under my care in which the
patient had attempted to arrest a diarrhoea which he had
had for several years, by taking large doses of acetate of
lead and opium. He succeeded in stopping it, but was the
next day attacked with headache and fever. Inflamma-
tion of the meninges of the brain supervened, and he died
in a few days.

The diarrhoea which attacks infants during the teething
process cannot be arrested with safety. Cerebral inflam-
mation or congestion is generally the consequence of suc-
cess in this direction.

Constipation is another condition of the intestines which
is habitual with some persons. Instances are on record in
which individuals have been several months without an
evacuation from the bowels, and with no derangement of
the general health. The case reported by Monte-Santo,*
of Padua, to the French Academy of Sciences, and which
was verified by MM. Grsefe and Frank from personal ex-
amination, is very remarkable, and might, very reasonably,

* Medico-Chirurgical Review, July, 1833, (American edition,) p. 236.

MORBID HABITS. 137

be doubted, but for the high characters of the observers.
In this case there had not been a discharge, per anum, for
fourteen years. There was always vomiting in from two
to five hours after each meal, and about once a month a
large quantity of fecal matter was discharged in the same
manner. Some time previously a case had been reported
to the Academy in which there had been no discharge of
feces or urine (by the ordinary channels at least) for a
period of seventy-two years.

Habitual constipation is extremely difficult of removal
by any merely medical treatment. Regular physical exer-
cise, with, above all, persistent efforts to have an evacua-
tion every day at a fixed hour, will be found far more
efficacious. By going regularly to the water-closet at the
same hour daily it will often happen that the difficulty will
be overcome. The influence of habit over these discharges
from the bowels is doubtless familiar to every one. When
regularity is established, the desire to go to stool returns at
the same hour. If the tendency is resisted, it is not long
before constipation becomes the rule.

Secretions and Excretions. The Skin. — The perspira-
tion may be abnormally large in quantity, or may be
altered in regard to its composition, without derangement
of the general health. We find some persons whose hands
and feet are always bathed in perspiration, or the excre-
tion may be profuse in other parts of the body. Weak
and phlegmatic individuals are those in whom excessive
perspiration is most generally encountered.

Fetid perspiration is also occasionally met with. It is
one of those affections which, though not disqualifying a
man for service in the army, should, out of regard to those
who may be his associates, lead to his rejection.

Many skin diseases are habitual, and cannot be cured, if
extensive, without danger to the general health. Great
care should therefore be exercised in treating them.

138 A TREATISE ON HYGIENE.

The Kidneys. — The amount of urine excreted is very
much controlled by habit, but there are so many other
factors entering into the matter that it is impossible to de-
termine with accuracy the extent to which habit alone is
capable of acting. The times of urination are obviously
regulated by habit. The desire to evacuate the contents
of the bladder returns without fail at the period of the day
when we are accustomed to empty this viscus.

The secretions of the mammary glands, of the salivary
glands, and other organs are also controlled, to a great ex-
tent, by habit, but present no features of peculiar interest
for our consideration in this connection.

The Generative Organs. — The morbid habits con-
nected with the generative organs are very important in
their physiological, hygienic, and moral relations. Some
are beyond the immediate control of the individual, while
others are more or less due to vicious propensities, which he
is able, if so disposed, to successfully combat. Many books
have been published in regard to them, but few writers have
risen to a sufficiently scientific and comprehensive view of
the subjects in question. There are many difficulties in
the way of treating of the abuses of the generative organs,
for what may be honestly intended as a warning may have
a directly opposite effect by exciting the prurient imagina-
tion of the reader. Persons who have not made them-
selves the victims of these vicious habits do not require
such books, while those who have indulged their passions
to an injurious extent are apt to disregard the warnings,
and gloat over the examples of licentiousness and debase-
ment which are unfolded to the imagination.

The abuse of the organs of generation is calculated to
lead to very serious results, though I think the extent to
which it is carried and the consequences which ensue from
it have been grossly exaggerated, for their own purposes,
by the designing mountebanks who flood the world with

MORBID HABITS. 139

their miserable books, and shock every feeling of modesty
by the shameless advertisements they crowd into the pub-
lic newspapers. But no doubt can exist relative to the
very injurious effects produced upon the organism by
the too frequent emission of the seminal fluid in males,
or the oft-repeated recurrence of the sexual orgasm in
females.

In masturbation the mischief is still greater, because, in
addition to the phenomena which accompany the sexual
act, the imagination is more or less brought into action to
produce the necessary mental impression. In this manner
the stimulus to the emission of semen, or to the correspond-
ing actions in the female, instead of being derived from the
natural source, has its origin in the mind. By frequent
repetition, the intellectual powers become weakened, and,
in extreme cases, epilepsy and imbecility are produced.

The act of masturbation in the male is far more in-
jurious than in the female, because it is accompanied in
the former case by a seminal loss, which does not attend
in the latter. The body therefore sooner becomes debili-
tated through the exercise of this pernicious habit in the
male than in the female.

For the elaboration of the semen the highest degree of
organic power is necessary. The testicles of very young
persons, whose systems are yet undeveloped, are not
capable of secreting this fluid; and toward old age, when
the organism is declining in strength, the power becomes
deficient, and is eventually altogether lost. The body
therefore becomes severely taxed if the emissions of the
seminal fluid are too frequent; sufficient time is not
afforded in the intervals for the system to recuperate, and
the semen which is secreted is imperfectly formed, and
does not possess the same vivifying power as that which
has been secreted through the ordinary and natural action
of the testicles.

The manifestations of deficient vital power in the organ-

140 A TREATISE ON HYGIENE.

ism are well marked. The digestion is generally the first
function which is affected. Dyspepsia becomes established,
and diarrhoea is not infrequently a troublesome and debili-
tating accompaniment. The circulating system partici-
pates. The action of the heart is feeble, rapid, and irregu-
lar; palpitations are almost constantly present, and upon
auscultation a bellows murmur is found to accompany the
ventricular contraction. The countenance parts with its
natural hue and becomes of a leaden color; the eyes lose
their luster, are deep sunk in the orbits, and are sur-
rounded by a bluish circle; the skin becomes dry and
harsh; and the hair, no longer nourished as it should be,
is deprived of its natural moisture and falls out.

The mental phenomena are not less striking. The mas-
turbator shuns society, becomes morose and low spirited,
and evinces an apathy for all kinds of amusements.
Eventually, if he perseveres in his vicious practice, the
debility becomes extreme, and either phthisis, epilepsy, or
some other organic disease is produced.

In the mean time the effect upon the generative system
is not to be overlooked. Emission takes place upon the
least provocation, sometimes without any manual inter-
ference, but solely through mental impressions, derived
through the imagination at the sight of some lascivious
picture or scene, and this without erection of the penis.
After a time, however, this faculty of easy emission is lost.
The glans becomes hard and callous, and loses its peculiar
irritability to the touch. More violent means of excitation
are therefore resorted to, which in turn become ineffica-
cious — and thus the miserable victim of his own pernicious
acts progresses step by step in his downward career till the
gratification of his passion becomes his only object in life,
and paralysis, conjoined with epilepsy and phthisis, unite
to terminate his unhappy existence.

The seminal fluid is in such cases, as we have already

MORBID HABITS. 141

stated, imperfectly formed.. It becomes thin, loses its
peculiar odor, and, on microscopical examination, is seen
to be wanting in the spermatozoa which give it its
fruitfulness. It appears to lack all the characters of
the fluid secreted by the testicles, and is probably
nothing but the prostatic liquid conjoined with a little
mucus. It occasionally happens that the fluid ejaculated
is mixed with blood. Even in cases where the abuse of
the generative organs is not carried to such an extent as to
induce phthisis and death, impotency is generally the con-
sequence of an inordinate loss of the seminal fluid con-
tinued over a few years, especially in those who have not
yet reached the adult age.

Such are some of the consequences of masturbation.
Medical literature abounds with the most revolting cases
of depravity in persons who have delivered themselves
over to this practice. Commencing in infancy, through
the teaching of nurses, learning at school, or being
prompted by the licentious character of much of the liter-
ature that reaches the hands of young persons, hundreds
yearly find an early grave, grow up weak, puny, and inca-
pable of procreating the species, or terminate their days in
an insane asylum. Though this condition of society is
painful to contemplate, I am satisfied, from much observa-
tion, that it is much less prevalent than is generally sup-
posed, or than the advertising charlatans of the day would

have us believe. .

With reference to the military life, the subject under
consideration is one of great importance, because there
is no doubt that the practice referred to is earned on
to a very considerable extent in all armies. The life of a
soldier is often such that he seeks diversion of any kind
that offers itself, and it too frequently happens that m
masturbation he finds for a time a relief from the ennui
of the camp. But if anything has a tendency to de-

142 A TREATISE ON HYGIENE.

moralize the soldier, to unman him, and to render him
incapable of attempting aught that requires courage or
endurance, it is the practice of this bad habit. Command-
ing officers have it in their power to prevent it to a great
extent by providing employment and recreation for the
men under their charge. Idleness is a great incentive to
it. When that is guarded against, masturbation is at its
minimum.

Much can be done to free an individual from the de-
grading habit under consideration. Young persons who
are suspected should have clearly pointed out to them, by
some one in whom they have confidence, the consequences
to which they subject themselves by a persistence in this
vicious practice. At the same time the mind should be
kept occupied with such matters as will tend to lead it
away from the contemplation of all lascivious ideas. A
well-regulated system of gymnastic exercises is of great
importance. Strong bodily exercise indisposes to venereal
desires.

Cold bathing is also an excellent anaphrodisiac. A cold
plunge-bath taken at night will be very apt to prevent the
occurrence of the erotic ideas which (in the earlier stages
of the practice at least) precede the act of masturbation.
Strong, stimulating food, condiments, and alcoholic bever-
ages should be avoided. In a word, the measures to be
employed are eminently hygienic. Many medicines have
obtained a reputation as anterotics, but I must confess that
I have seen but little benefit derived from their use, with
the exception of iron, the therapeutic action of which is
due altogether to its tonic properties.

Involuntary Emissions. — Emissions of semen may take
place without any venereal desire, or without friction of
the glans or other part of the penis. They may occur
either during the day or night, and may be the natural
result of distention of the vesiculae seminales or due to a

MORBID HABITS. 143

deficiency of tone and power in the generative part of the
organism. If not excessive, they cannot be said to be in-
jurious, especially when they occur at night only. But if
they happen often, the results do not materially differ from
those which follow immoderate venery or masturbation.
Occasionally nocturnal pollutions are accompanied by
erotic dreams, but this is not generally the case.

When due to repletion of the vesiculae seminales, in-
voluntary emission may be regarded as purely natural,
and as effecting a healthy purpose of the economy. In
youths who have just reached the age of puberty they
often occur from this cause, and, if happening not more
frequently than once or twice a month, are decidedly salu-
tary in their influence. It sometimes, however, is the case
that they are produced night after night, and the subject
of them awakes in the morning, instead of refreshed, de-
pressed both in mind and body, and experiencing a degree
of lassitude which unfits him, throughout the early part of
the day, for much physical or intellectual exertion. Night
is dreaded on account of the inevitable occurrence and the
disagreeable consequences which follow.

The hygienic measures which have been recommended
in masturbation are still more efficacious in involuntary
emissions, and the influence of medicines is not altogether
to be despised. A pill of camphor and opium taken on
going to bed, and continued for a week or two, will often of
itself effect a cure. The habit, once broken, is not apt (if
proper hygienic means are adopted) to recur.

However we may explain the fact, there can, I think,
be no doubt that sleeping on the back is a powerful cause
of nocturnal emissions. I have had many cases under my
care which were clearly traceable to this cause, and which
were cured by the patient avoiding altogether the supine

position.

Sea-bathing, a bracing mountain air, and whatever else

144 A TREATISE ON HYGIENE.

is calculated to strengthen the system, can scarcely fail to
produce the best results in those cases which are accom-
panied by debility or an originally weak constitution. As
has been already intimated, involuntary emissions occur-
ring infrequently, and in persons of strong physical de-
velopment, had better be left to be dealt with by nature
alone, for so far from being injurious, they are calculated to
exercise an effect more beneficial than otherwise.

In the female sex we meet with morbid habitudes which
have their seat in the generative organs, but which do not
owe their existence to any act of the individual, but are
deviations from the healthy standard of functional action.
Thus the process of menstruation may offer individual
peculiarities either in regard to the regularity of its occur-
rence or the quantity of blood discharged at each period.
These are not necessarily attended with any derangement
of the health in other respects, and are scarcely subjects
for the interference of the physician so long as the general
system is not injuriously involved, or distant organs sympa-
thetically affected. Even in such cases more benefit will
be derived from hygienic measures than those purely
medical.

It must be confessed that American women are very
subject to derangement in the menstrual function. This
liability is doubtless due to the fact that they pay so little
attention to the ordinary rules of health as regards ex-
ercise, clothing, the heating and ventilation of their
dwellings, etc.

Habitual leucorrhcea is common among women. The
same causes which give rise to irregularities of the men-
strual function induce leucorrhcea. An eminent obstetri-
cian informed me not long since that more than half of his
female patients were subject to this disease. The flow
may be profuse and yet the general health remain undis-
turbed; more frequently, however, the system sympa-

CONSTITUTION. 145

thizes and becomes debilitated and relaxed. Efforts
should always be made to restore the healthy condition
of the parts, and here again exercise, cold bathing, sea or
mountain air, attention to diet, to clothing, etc. are the
most powerful means at our command.

CHAPTER X.

CONSTITUTION.

By constitution we understand the general condition of
the system which is due to the permanent state of the
organs of the body. A person may have either a good or
a bad constitution, according to the more or less perfect
construction and action of the organs by the operation of
which life is maintained. In the former case the vitality
of the body, the capability for resisting morbific influences,
and of recuperation, are greater than in the latter, the
functions are performed with energy, the tissues are
healthy, and as a consequence derangement and disease
are not so liable to occur. On the contrary, persons with
weak constitutions are prone to disease upon slight expo-
sure to the operation of causes capable of inducing patho-
logical disturbance. The circulation is weak and languid,
and in the extremities, consequently, the temperature is
not kept up to the normal standard. Such individuals
suffer severely from attacks of disease which a person of
strong constitution would pass through without difficulty.
It is very much with man as with an artificial machine.
If the latter is well made, of good material, the several
parts strongly put together and working in harmony with
each other, it will resist hard usage better than one which

146 A TREATISE ON HYGIENE.

is made of bad materials, and in which the different parts
are not well proportioned, and are constructed without a
due regard to the work they have to perform.

Constitution differs from temperament, with which it
has sometimes been confounded, in this, that while the
latter refers to specific and well-defined differences, due to
the particular manner in which certain vital processes re-
act on the mind, the former is more general, and relates to
the original structure and integrity of the organs and tis-
sues of the body. An individual may possess any tem-
perament conjoined with either a good, bad, or indifferent
constitution. Constitutions differ from each other only in
degree of perfection, while the differences between tempera-
ments are peculiar and radical.

A weak constitution is, to a certain extent, capable of
being strengthened by proper hygienic measures. A child
born in poverty, and reared under circumstances unfavor-
able to the full development of the organs of the body,
such as insufficient food, clothing, light, and fresh air, may,
if the conditions are changed at a sufficiently early period,
develop into an adult of good constitution. Even at a late
period of life much may be done by the employment of
sanitary means to strengthen a constitution originally
feeble.

The evidences of a feeble constitution are generally suf-
ficiently clear to even a superficial observation. The heart,
the lungs, and the nervous system are found to be endowed
with less than the normal amount of power, and conse-
quently the functions appertaining to these organs are im-
perfectly performed. The chest is narrow and flat, the
muscles flabby and weak, and the whole system is wanting
in tone. As has been already said, persons of weak con-
stitutions do not make good soldiers. They have neither
the mental nor physical endurance requisite in those who
enter the military service.

CONSTITUTION. 147

A naturally strong constitution may be weakened by ex-
cesses, or a neglect of the rules of health. The excessive
use of alcohol, inordinate sensual gratification, long-con-
tinued exposure to the action of causes capable of depress-
ing the vital powers, and frequent attacks of disease, will
break down the strongest constitutions. Many soldiers are
thus rendered unfit for service. Originally well constituted
and robust, the hardships incident to an active campaign —
exposure to all kinds of weather, loss of sleep, want of suf-
ficiently nutritious food and warm clothing, the absence of
proper shelter — all tend to impair the normal standard of
health. Tissues which in the first place were capable of
performing their office in the economy, lose this power in a
measurable degree, and the whole organism becomes enfee-
bled and more susceptible to morbific influences.

It is in early childhood that most can be done to modify
original defects of constitution. Weak and sickly children
require the utmost care in regard to food, clothing, exercise,
etc. A strong meat diet, or at least an abundance of milk,
eggs, or other animal food, is absolutely necessary, when it
is considered desirable to improve the tone of the system.
Much injury is done to children by confining them, as is
often done, to a vegetable diet and milk and water. Such
children generally remain weak and puny, and become
adults of feeble constitutions. The process of hardening, as
it is called, is one fraught with danger to the subject upon
whom it is tried. Persons of originally sound and robust
organization may, by judicious exposure to cold and moist-
ure, become strengthened by the development of their ener-
gies ; but those who are of feeble constitution are more apt
to be overcome than to conquer under such circumstances.

SECTION III.

OF AGENTS EXTERNAL TO THE ORGANISM WHICH ACT
UPON THE HEALTH OF MAN.

CHAPTER I.

THE ATMOSPHEEE.

The air is a compound gas of variable density surrounding
the globe, and dissolved in the water which constitutes a part
of its matter. It is necessary to the life of all organic beings
whatsoever. It extends above the earth nearly forty-five
miles, and at the level of the sea exerts a pressure of about
fifteen pounds to the square inch. The composition of the
atmosphere, according to the researches of MM. Dumas and
Boussingault, is 208 measures of oxygen and 79 - 2 of nitro-
gen. It also contains a variable proportion of carbonic
acid and aqueous vapor, with traces of iodine, ammonia,
and nitric acid. In certain localities other substances enter
into its composition, and exert a more or less deleterious
influence upon life, and several of the matters which are
constantly present in small quantity, when materially in-
creased in proportion, render the atmosphere unfit for res-
piration.

For the purposes of respiration in animals, the essential
constituent of the atmosphere is the oxygen, the nitrogen
merely serving as a diluent, and not being absorbed into
the system through the lungs. It is by volume, as we have
seen, about one-fifth the total bulk; but within certain
(148)

THE ATMOSPHERE. 149

limits this proportion is probably subject to variation,
according to the situation of the locality where the air is
collected. Thus, along the sea-shore, M. Morren found the
amount of oxygen in 100 volumes of air to reach 23*67
parts. Dalton, and subsequently M. Babinet, found that
the proportion of oxygen sensibly diminishes as the alti-
tude increases, so that, according to the lasi>named ob-
server, at the height of 10,000 metres above the level of
the sea, the quantity of oxygen in 100 volumes of atmos-
pheric air is but 18 12.

Boussingault, who examined the air collected from the
Andes, and Brunner, who analyzed that of the Faulhorn,
came to the conclusion that the composition of the atmos-
phere does not vary for altitude. The experiments of
Dumas* are to the same effect; but Lewyf found the air
collected at sea, and but a few feet above its surface, to
contain less oxygen than the air of the land.

The atmosphere is not, therefore, a fixed chemical com-
pound, but simply a mechanical mixture of oxygen and
nitrogen in perhaps variable proportions, to which are
added certain other gaseous matters, also in no certain

quantities.

The physiological and chemical properties of oxygen
are such as render it the most important constituent of
the atmosphere. It is the element which, above all others,
is most powerful in maintaining life, and, at the same
time, is that which exerts the greatest influence in effect-
ing the destruction of all organic forms. It also enters
into combination with all elementary substances, with
the single exception of fluorine. Pure oxygen, when in-

* Annales de Chimie et de Physique, 1841, tome lxxviii. p. 257.

t Kaemtz Cours Complet de Meteorologie, p. 66 ; see also Annales de
Chimie et de Physique, 1843, tome viii. p. 425, for M. Lewy's observations
in full.

150 A TREATISE ON HYGIENE.

haled, is not capable of supporting life for any consider-
able period. It acts so energetically that life is destroyed
just as we see a piece of charcoal, which burns gradually
and without commotion in atmospheric air, consume
rapidly and with a burst of scintillations, when ignited
in pure oxygen.

Inhaled in a diluted form, as it exists in the atmosphere,
oxygen unites with the carbon of the blood and is expired
as carbonic acid. A portion of it enters into other com-
binations, which are excreted by the kidneys and skin,
being the products of the destructive metamorphosis of the
animal tissues.

The property which the atmosphere possesses of sup-
porting combustion is due entirely to its oxygen. But
this fact affords no certain indication that air in which
combustion is maintained is fit for respiration. Life soon
becomes extinct in an atmosphere in which a candle will
continue to burn, as can be shown experimentally.

Nitrogen is in many respects the very opposite of
oxygen, its properties being almost entirely negative. It
does not support combustion, and though it is found as a
constituent of all the animal tissues except fat, it is not
capable of answering the purposes of respiration. An ani-
mal confined in an atmosphere of nitrogen dies as quickly
as it would in a vacuum.

As has been said, there are other matters found in the
air which, though not essential to its composition, are too
important in their influence upon health to be disregarded.
Some of these are gaseous, as carbonic acid, ozone, etc., and
others are morphological, as spores of fungi, infusoria, etc.
These we propose to consider in the following chapter.

NON-ESSENTIAL CONSTITUENTS OF THE ATMOSPHERE. 151

CHAPTER II.

THE ACCIDENTAL OR NON-ESSENTIAL CONSTITUENTS OF THE

ATMOSPHERE.

The matters embraced under this head are those which
are not regarded as essential to the composition of the
atmosphere, though generally present in it as a whole, or
in the air of certain localities.

Carbonic Acid. — This substance is present ordinarily
in the proportion of from four to six parts in ten thou-
sand of air; but, under certain circumstances, this ratio is
very considerably augmented. It is greater at night than
in the day by almost one-third, owing, perhaps, to the fact
that, through the influence of the sunlight, it is absorbed
from the atmosphere by plants. The proportion of carbonic
acid present in the atmosphere is greater according as the
altitude increases, the air collected from around the sum-
mits of high mountains containing more than the air of the
plains. It is also present in larger quantity in the atmos-
phere of cities than in that of the country — MM. Boussin-
gault and Lewy finding at Andilly, in 10,000 parts of
air, 2909 of carbonic acid, and at Paris 3-190. Dr. Ramon
de Luna* found that the air within the walls of the city of
Madrid contained in the mean 051 7 parts of carbonic acid
in 1000 of air, while without the walls the mean quantity
was but 0-45.

Ramon de Luna also examined the air of bed-rooms be-
fore and after ventilation. The air collected from one of

* Etudes Chimiques sur l'Air Atmospherique de Madrid. Annales
d'Hygiene, tome xv. 2d serie, p. 337.

152 A TREATISE ON HYGIENE.

them at six o'clock in the morning was found to contain 4-8
parts of carbonic acid in 1000, with a very appreciable
amount of organic matter, while, after two hours' .complete
ventilation, the proportion of carbonic acid was reduced to
1-6, and the organic matter, though still present, was in
less quantity. Thus, even after the " complete ventilation,"
the proportion of carbonic acid present in the room was
more than five times what it ought to have been.

Leblanc* found the amount of carbonic acid in one of
the wards of the Salpetriere to be as high as 6 parts, by
weight, in each 1000 parts of air; equivalent to 4 parts by
volume, which is ten times the ordinary proportion. In
another ward it very considerably exceeded this quantity,
being 8 parts in 1000.

In a room containing 1280 cubic feet of air, in which I
slept, and in which all the openings were carefully closed,
I found in the morning at seven o'clock 0*95 parts of car-
bonic acid to the 1000 of contained air — somewhat over
twice the ordinary quantity. After free ventilation by a
strong current of air passing through it for three hours, the
amount of carbonic acid was reduced to 0-43, or about the
normal quantity. When we come to consider the subject
of ventilation, we will treat of this matter more at length.

Carbonic acid, when pure, is irrespirable ; the glottis
closing spasmodically, prevents its entrance into the lungs.
Even air containing as much as 40 per cent, cannot be
respired. Leblancf having placed a dog, a Guinea-pig, a
bird, and a frog in a close vessel of 22*5 metres cubic
capacity, supplied it with a large quantity of carbonic acid.
After seven minutes the dog appeared to be uneasy, and
after three-quarters of an hour he was suffering severely ;
the bird and the Guinea-pig likewise suffered a good deal,

* Annales de Chiraie et de Physique, tome v. 1842, p. 223.
f Annates d'Hygiene, tome xxx. ler serie, 1843, p. 54.

NON-ESSENTIAL CONSTITUENTS OF THE ATMOSPHERE. 153

and the frog was very much inflated. The air collected at
this time contained 30-4 per cent, of carbonic acid. Not-
withstanding this large amount of impurity, the animals
all recovered when exposed to fresh air.

The experiments of Regnault and Reiset* show that an
atmosphere containing as much as 23 per cent, of carbonic
acid will support life, provided at least 40 per cent, of
oxygen be also present. Bernard,f on the other hand,
found that a bird died in two hours and a half in an at-
mosphere containing 39 parts of oxygen, 48 of nitrogen,
and 13 of carbonic acid. Bernard's experiment is, however,
open to the objection that the air was confined and loaded
with the organic exhalations from other animals which he
had previously placed in the bell-glass.

I confined a sparrow under a large bell-glass, having two
openings. Through one of these I introduced every hour
1000 cubic inches of an atmosphere containing 45 parts of
oxygen, 30 of nitrogen, and 25 of carbonic acid, allowing
the vitiated air in which the animal had respired partially
to escape. At the end of twelve hours the bird was in as
good a condition as at the commencement of the experiment,
and when the bell-glass was raised, it flew away as if nothing
had happened to it. A mouse subjected to a similar ex-
periment also suffered no inconvenience.

Experiments of this character would lead us to the con-
clusion that carbonic acid is not positively poisonous, but
only negatively so, when its presence is unaccompanied by
a due amount of oxygen. When this latter gas is present
in the proportion of two parts to one of carbonic acid, life
can be sustained. Direct experiment also leads to the
same conclusion. I have repeatedly injected carbonic acid

* Recherches Chimiqnes de la Respiration des Animaux des diverses

Classes. Paris, 1849.

f Le 9 ons sur les Effets de Substances Toxiqnes, etc., p. 132.

154 A TREATISE ON" HYGIENE.

gas into the cellular tissue of rabbits and dogs without the
least injurious result, and have even introduced it with
impunity directly into the blood. •

The cases which are on record of the frightful results
which have followed the crowding together of many per-
sons in circumscribed areas, are ascribable to two causes —
the deprivation of oxygen, and to the emanations from the
bodies of the sufferers. The instance of the one hundred
and forty-six Englishmen confined in the Black Hole at
Calcutta, a room eighteen feet square, and with but two
small windows, illustrates these points. Mr. Holwell,* who
was one of those imprisoned, has given a very graphic
account of the torments he and his companions endured.
He specifically refers to the urinous odor which pervaded
the prison, and the symptoms, as described by him, are
such as would be produced by intense animal poisoning.
He says : " Here my poor friend, Mr. Edward Eyre, camp
staggering over the dead to me, and, with his usual coolness
and good nature, asked me how I did, but fell and expired
before I had time to make a reply." No asphyxiated per-
son could have acted in this manner. Of the one hun-
dred and forty-six imprisoned at eight o'clock in the
evening, all but twenty-three were dead by six o'clock next
morning.

Many other instances might be adduced, showing the
fatal effects of over-crowding ; all of them indicating that
the organic matters exhaled from the bodies of the victims
were more at fault than the carbonic acid. This whole
subject will engage our attention more fully hereafter.

Owing to the greater density of carbonic acid gas, it occu-
pies the lowest stratum of the atmosphere in places where
it is confined. Thus, in vats it is always found at the
bottom. In the Grotto del Cane, near Naples, it extends

* Annual Register, 1758, p. 282.

NON-ESSENTIAL CONSTITUENTS OF THE ATMOSPHERE. 155

but for a few inches above the ground. A man can walk
through the place with perfect safety, but a small dog falls
asphyxiated at once. For this reason, patients in hospitals
should be placed on bedsteads in preference to being made
to lie on the floor.

The opinion is not intended to be expressed that an
amount of carbonic acid in the atmosphere over the normal
quantity is not injurious. It is hurtful, inasmuch as to the
extent that it is present it prevents the absorption of a
corresponding amount of oxygen.

Iodine. — The existence of iodine in the atmosphere, first
affirmed by Chatin,* has been assented to by some investiga-
tors and denied by others. Chatin's observations were con-
firmed by a commission of the French Academy of Sciences,
and subsequently by Mr. T. J. Herapath,f of Bristol, in
England. Herapath caused the air to impinge upon a glass
slide on which a mixture containing starch was placed.
After a period varying according to the direction of the
wind, the state of the atmosphere as to moisture, etc., the
glass always, when submitted to microscopical examination,
showed the presence of iodine in the blue color of the starch
granules. I have several times repeated Herapath's ex-
periments, and always with affirmative results. There
would appear, therefore, to be no doubt on the subject.
No very exact results have been obtained relative to the
absolute amount of iodine in the atmosphere, but compara-
tive observations show that it is more abundant in the
vicinity of bodies of water than in other localities. The air
of the sea-side contains it in comparatively large proportion.
On the contrary, the air about the summits of high mount-
ains, and also that of the valleys, is deficient in it, as is
likewise the water of these situations.

* Comptes Rendus de l'Academie des Sciences, tome xii. p. 1006.
f Chemist, vol. iv., 185T, p 193.

156 A TREATISE ON HYGIENE.

The principal source of the iodine of the atmosphere is
water, both that of the sea and of the rivers and springs.
A great portion of the benefit derived by invalids from a
residence at the sea-shore is to be ascribed to an increased
amount of iodine taken into the system through the lungs.
The expired air contains but a fifth part of the iodine of
the inspired air, the balance being fixed in the blood.

Sulphuretted Hydrogen. — This gas is only found in the
atmosphere collected from localities where decomposition
of organic matter or certain inorganic substances is pro-
gressing. Thus it is exhaled from sewers, cesspools, and
privies, and is also disengaged from marshes, rivers, and
mines and volcanoes. Sulphuretted hydrogen is exceed-
ingly poisonous. Dupuytren* found that ~ of this gas
was sufficient to render the atmosphere so poisonous that
small birds were killed in a few seconds when subjected to
its influence. One part to two hundred and ninety-nine
parts of atmospheric air proved fatal to a dog. Chaussierf
found that one part in two hundred and fifty of air sufficed
to kill a horse. On the other hand, a commissionj ap-
pointed by the Parisian authorities to examine into the
best means of cleaning the sewers of Paris, and composed
of MM. D'Arcet as president, Gaultier de Claubry, Parent
Duchatelet, and others, found that their workmen could
breathe, without inconvenience, an atmosphere containing
one per cent, of sulphuretted hydrogen, and that they con-
stantly breathed air in which from twenty-four to ninety
thousandths were present. On one occasion Gaultier de
Claubry remained sufficiently long in a sewer to collect the
air, which, upon analysis, was found to contain 2-99 per
cent, of sulphuretted hydrogen.

* Dictionnaire des Sciences Medicales, tome ii. p. 391.
f Journal de Medecine de Sedillot, tome xv. p. 28.
J Aunales d'Hygiene, 1829, tome ii. p. 1 et seq.

NON-ESSENTIAL CONSTITUENTS OF THE ATMOSPHERE. 157

Drs. Christison and Turner* found that four cubic inches
and a half of sulphuretted hydrogen, diluted with eighty
volumes of air, caused the death of a mignonette plant.

Halle describes at length the effects of this gas on man
as it was exhaled from certain privies of Paris. When in-
haled in a concentrated form, sudden weakness and com-
plete asphyxia are produced. The individual becomes
weak and insensible, and falls down dead without convul-
sive action. If the quantity of sulphuretted hydrogen be
moderate, the symptoms are more varied; vertigo, coma,
convulsions, and vomiting are caused. Death ensues if
the individual be not quickly removed into the fresh air.

The results of my own experiments with sulphuretted
hydrogen do not differ materially from those of other ob-
servers. I found, with Dupuytren, that all small animals,
as birds and mice, were killed by a smaller proportion of
the gas in the atmosphere in which they were confined
than larger animals. Sparrows and mice did very well in
an atmosphere ^Vo of which was sulphuretted hydrogen.
With more than this, death ensued, though not till twenty
or thirty minutes had elapsed. These animals, if placed
under a bell-glass containing pure sulphuretted hydrogen,
died immediately, without any convulsive action. On
post-mortem examination, the blood was found perfectly-
dissolved, and the blood corpuscles completely broken

down.

The action of sulphuretted hydrogen, when inhaled in
large quantity, appears to be that of a narcotic poison.
Its effects upon the organism, when its action is long con-
tinued in small amount, have not been so thoroughly in-
vestigated as is desirable. That it is capable of producing
injurious results, is very certain. Dr. Christisonf states

* A Treatise on Poisons, etc., by Robert Christison, M.D. Am. ed.,
p. 618.

t Ibid., p. 620.

158 A TREATISE ON HYGIENE.

that at one time, when he took no precautions against in-
haling the gas, he remarked that daily exposure to it in
small quantities caused an extraordinary lassitude, languor
of the pulse, and defective appetite. Dr. Taylor* refers to
the instances which occurred of poisoning by this gas in
the workmen engaged in excavating the Thames Tunnel.
By respiring the atmosphere of this place the strongest
men were in a few months rendered extremely weak, and
several died. The symptoms were giddiness, nausea, and
extreme debility; fever, accompanied by delirium, super-
vened. In one case which Dr. Taylor saw, "the face of the
man was pale; the lips were of a violet hue; the eyes
sunk, with dark areola? around them; and the whole
muscular system flabby and emaciated."

Dr. Daniell and others have supposed that the active
agent of malaria in causing fevers is sulphuretted hydro-
gen. Although there is no doubt of the exhalation of this
gas from marshes, rivers, and other places, giving rise to
malaria and the consequent production of fevers, there is
no proof that it is the principle to which these diseases owe
their origin. On the contrary, the symptoms produced by
sulphuretted hydrogen have very'little analogy with those
caused by malaria.

The disease which occurred a few years since at the
National Hotel in Washington was undoubtedly due to
emanations from a sewer, the active agent of which was
probably sulphuretted hydrogen. A stream of gas from
a sewer, sufficiently strong to extinguish a lighted candle,
was found flowing into the cellar of the house. The symp-
toms produced were very similar to those observed by Dr.
Taylor in the workmen of the Thames Tunnel. After
death, ulcerations of the small intestines and inflammation
of the mucous membrane of the colon were observed.

* Medical Jurisprudence. Am. ed., p. 609.

NON-ESSENTIAL CONSTITUENTS OF THE ATMOSPHERE. 159

Sulphuretted hydrogen is readily detected by its action
on the salts of lead. A slip of paper, moistened with a
solution of the acetate of lead, for instance, becomes brown
or almost black, from the formation of sulphuret of lead,
when subjected to the influence of an atmosphere contain-
ing this gas.

Carburetted Hydrogen. — The carburetted hydrogen
gases, which are those used for illuminating purposes, are
also found in the atmosphere as evolutions from decom-
posing organic remains, or as escaping from mines, vol-
canoes, etc. Though deleterious, they are not so poison-
ous as sulphuretted hydrogen, and may be inhaled in a
tolerably concentrated form without much inconvenience.
Sir Humphrey Davy inhaled a mixture of two parts of air
and three of carburetted hydrogen. He immediately be-
came giddy and faint. He then inhaled it in a pure state.
The first inspiration produced numbness in the muscles of
the chest; the second caused great oppression of the lungs;
at the third inspiration he nearly lost consciousness, be-
coming at the same time very weak and faint. In less
than a minute he again became sensible, but the feeling of
impending suffocation and weakness continued for some
time. It is probable that the mixture contained carbonic
oxide, to which the effects produced were mainly due.
The carburetted hydrogen was formed by the decompo-
sition of water by red-hot charcoal.

Several instances are on record of death being pro-
duced by the inhalation of impure carburetted hydrogen.
Devergie* gives the history of a case in which one person
died, and four others nearly perished, in consequence of
sleeping in a room in which the gas-pipe leaked.

Carburetted hydrogen gases are disengaged in consider-

* Asphyxia par le Gaz de l'Eclairage, etc. Ana. d'Hygiene, tome iii.
p. 457.

160 A TREATISE ON HYGIENE.

able abundance from coal mines, and are inhaled, unless in
a concentrated form, with impunity by the miners. The
very decided odor which belongs to them serves as a
warning of their presence.

It would appear that the deaths caused by illuminating
gas have been due to carbonic oxide, present as an im-
purity, more than to the carburetted hydrogen of either
kind. I caused a rabbit to inhale a mixture of pure light
carburetted hydrogen (prepared by heating four parts of
dried acetate of soda, four of fused potassa, and six of
quicklime) and atmospheric air, in the proportion of one
part of the former to two of the latter, without any notable
symptoms being produced. Even when in equal propor-
tion with the air, the animal did not appear to suffer. Ole-
fiant gas was likewise found to cause but little inconveni-
ence when employed in the same proportions. Two parts
of either mixed with one of atmospheric air caused death
in about half an hour, more from the deprivation of
oxygen apparently, than from any positively poisonous
influence exerted by the gases in question. I have also
injected them directly into the blood with impunity.
Illuminating gas obtained from the distillation of coal
always contains an appreciable quantity of carbonic oxide,
to which its directly toxic power is due.

The difference in the results obtained by causing animals
to inhale the ordinary illuminating gas is well marked. I
have frequently subjected birds and rabbits to its action,
and even when present in as small a proportion as the for-
tieth of one per cent., death was caused in a few minutes.
When pure, the animals were killed at once.

Light carburetted hydrogen is given off in large quan-
tities from marshes, and it has been assumed that it is the
morbific agent which is present in malaria. There is no
reason, however, to support this view.

NON-ESSENTIAL CONSTITUENTS OF THE ATMOSPHERE. 161

Nitric Acid and Ammonia. — These substances are nor-
mally present in the atmosphere. According to Fresenius,
one million parts of atmospheric air contain during the
day "098 parts of ammonia, and during the night -169
parts. The nitric acid is found in larger quantity during
and immediately after thunder-storms. It is not known
that they exert any particular effect upon the health of
man, as their quantity is extremely small.

Ozone. — Various opinions have been expressed by
chemists relative to the nature of this substance, which
was discovered, in 1839, by Schonbein, as a constituent of
the atmosphere. According to the views of this investiga-
tor there are two allotropic conditions of oxygen: one,
that which is constantly present in the atmosphere in
fixed proportion; the other, which is occasionally present,
and which may be formed from ordinary oxygen by
various agents, the principal of which are electricity and
phosphorus, is designated as ozone, a term— from 6C^, to
stink— which sufficiently expresses one of its characteris-
tics. Schonbein originally regarded ozone as a gaseous
peroxide of hydrogen; but his later investigations have
led him to the conclusion that it is oxygen in an active
state— in fact, an allotropic form of that element. In this
view he coincides with the opinion held by Berzelius,
De la Rive, and others, and which has since been sus-
tained by Dr. Andrews* in a very complete series of

experiments.

Ozone is formed whenever electricity is passed through
a column of atmospheric air. The peculiar odor which is
evolved from the working of an electrical machine is due to
the formation of ozone. It may also be produced by decom-
posing aqueous solutions of certain acids and salts by gal-

* Quarterly Journal of the Chemical Society of London, 1857, vol. ix.
p. 169.

162 A TREATISE ON HYGIENE.

vanism, the ozone appearing with the oxygen at the positive
pole. When phosphorus is slowly oxidized in atmospheric
air, ozone is formed. Marignac produced it readily by draw-
ing air through a long glass tube containing a few pieces
of pure phosphorus. The ozonized air was then passed
through water to absorb the phosphoric acid, and collected
in a bell-glass. Phosphorus placed under a bell-glass, in
presence of a little water, causes the formation of ozone.
It is also probably produced when two flints are rubbed
together, though Prof. Hare* failed to recognize it.

Ozone formed by either of these methods possesses the
power of setting iodine free from its combination in iodide
of potassium, and upon this fact depends the value of the
test which is commonly used to indicate its presence. A
mixture made of one part of iodide of potassium, ten parts
of starch, and one hundred parts of water constitutes the
reagent. A piece of white filtering paper moistened with
this compound, and exposed to the influence of ozone,
becomes brown or bluish, from the action of the iodine set
free upon the starch, whereby an iodide of starch is
formed. This reagent is not, however, a positive indica-
tion of the presence of ozone, for nitric acid and several
other substances likewise possess the property of setting
iodine free from its combination with potassium, and ac-
cording to Cloe'z certain vapors and oils given off from
vegetable matters exercise a similar power. Nitric acid,
being an almost constant constituent of the atmosphere,
may give rise to a serious source of fallacy in the use of
the test in question.

Ozone is a very powerful oxidizing agent. The moist-
ure which is deposited as dew contains it in considerable
proportion, and it is on this account that iron so readily
rusts when exposed to dew.

* Silliman's Journal, 1851, vol. xii. p. 434.

NON-ESSENTIAL CONSTITUENTS OF THE ATMOSPHERE. 163

In its effects upon the health of man it is highly prob-
able that ozone exerts a very powerful influence, although
as yet we are unable to adduce any positive evidence on
the subject. Schonbein, as far as his investigations ex-
tended, was of the opinion that it is highly provocative of
bronchial affections, and especially of influenza. During
an epidemic of this disease he found an augmented
quantity of ozone in the atmosphere.

From his experiments, Schonbein also concluded that
ozone is absolutely destructive of malaria. So far as this
point can be determined from the effect of ozone in neu-
tralizing the odor of putrefying animal and vegetable sub-
stances, there can be no doubt of the correctness of this
opinion. I have been able to confirm it entirely by subject-
ing putrescent meat and vegetables to the action of ozone
in very small quantity, and invariably the bad smell was at
once corrected. But such experiments afford no conclusive
proof that ozone can counteract the effects of malaria, for
as yet we are not positively certain in regard to the nature
of this agent, still less can we say that it is the matter
which causes the peculiar odors of putrescent substances.
According, then, to the views of this investigator, when there
is an abundance of ozone in the atmosphere malarious dis-
eases prevail but to a limited extent, if at all. In winter
ozone is present in a greater amount in the atmosphere
than during the summer months, and this fact is brought
forward by Schonbein in confirmation of his conclusions,
for, as is well known, miasmatic affections are more preva-
lent during the latter than the former season. He also
found that the higher strata of the atmosphere contained
more ozone then those nearer the general surface of the
earth, and as malarious diseases are less prevalent in high
altitudes than in the low lands, he finds in these facts
further confirmation of his views. Although the facts
stated are strong presumptive evidence in favor of his

164 A TREATISE ON HYGIENE.

theory, they are far from being conclusive. Clemens,* by
a series of very interesting experiments, appears to have
established the fact of an antagonism existing between
ozone and malarious emanations; and several other ob-
servers have, by independent observations, arrived at
similar conclusions.

With reference to the influence of ozone over the pro-
duction of cholera, there is also a difference of opinion.
Whether any direct relation exists between the quantity of
ozone in the atmosphere and the prevalence of cholera or
not, there appears to be no doubt that the presence of this
disease is generally accompanied by a minimum amount
of ozone in the air of the locality where it prevails.
Berigny,-j- who made a large number of important obser-
vations relative to ozonometry at Saint Cloud, found that
there were more cases of cholera among the soldiers who
inhabited the first story of the barrack there than in the
upper stories, and that the atmosphere of this first floor
contained less ozone than that of the other floors.

Leaving the investigations of others, I come to my own
experiments in relation to ozone and its connection with
the occurrence of diseases.

With Schonbein I found that ozone is exceedingly de-
structive to animal life, and that birds or mice, when
placed in an atmosphere containing not more than — ' —
of ozone, died in a few minutes, with all the symptoms of
asphyxia. The mere smelling of it was sufficient to excite
in me a violent irritation of the Schneiderian and bron-
chial mucous membranes, which lasted for several hours.
This action was one which Schonbein had previously no-

* Comptes Rendus, July 7th, 1856.

f Rapport sur les Observations Ozonometriques, etc. Recueil des
Memoires de Med., de Chir., et de Pharm. Mil. 1856, tome xviii. p. 480
et seq.

NON-ESSENTIAL CONSTITUENTS OF THE ATMOSPHERE. 165

ticed, and which led him to the supposition of the super-
abundance of ozone during catarrhal epidemics.

At Fort Riley, in Kansas, where I was stationed several
years since, I observed that the workmen who lived in the
low alluvial region of country bordering the river were ex-
tremely subject to intermittent fever, while those, with the
soldiers, who inhabited the barracks built on the high
ground about half a mile from the river, were not at all
affected. I found, by using Schonbein's ozonometer, that
ozone was, during the warm season, present but in very
small quantity in the atmosphere of the former locality,
while in the latter it existed in much larger proportion.
My observations were numerous on this point, and led to
uniform results.

During my service at that post cholera prevailed on two
occasions to a very great extent. While it continued, the
air was dry and contained no ozone. At least the ozonome-
tric paper failed to exhibit the slightest change in forty-
eight hours. The occurrence of a very severe thunder-
storm put an end to the epidemic in both instances, and
ozone at once reappeared in the atmosphere.

These results diner from those obtained at New York in
1849 by Prof. Ellet* during the prevalence of cholera.
This observer found no definite relation existing between
the amount of ozone in the atmosphere and the extent to
which the cholera prevailed.

It must be very evident to all students of this subject
that still further researches are necessary before we can
attain to any certain knowledge in regard to it. No doubt
can exist that there is a principle in the atmosphere,
whether it be ozone or not, which possesses the power of
setting iodine free from potassium, and which holds inti-
mate relations with the causes of certain diseases to which

* Transactions of the American Medical Association, 1850, vol. iii.

166 A TREATISE ON HYGIENE.

mankind are liable. Some later writers deny that ozone is
ever present in the atmosphere. We are not able to say
positively that it is; we only know that there is an element
present which possesses the reaction of ozone. Till our
ozonometrical processes are improved, it is not probable
that we will arrive at any more definite information.
There is every assurance that a vast field of inquiry exists
in this direction, the investigation of which cannot fail to
enlighten us relative to the causation of many diseases
which now defy our utmost powers of research.

Organic Matters. — The various living animals and
vegetables of the earth give off emanations from their
bodies, either in a gaseous or morphological state, which
are received into the atmosphere, and affect, in greater or
less degree, the hygienic condition of man. To the organic
matters emanating from the human body, more than to
any other cause, the injurious results of overcrowding are
to be ascribed. These exhalations escape from the lungs
and skin, and are principally in the form of vapor. They
are absorbed by the clothing, the bedding, the carpets, the
curtains, and many other materials, and even the walls of
the rooms inhabited take them up and retain them for a
long time.

It is impossible to describe in detail the characters of
the organic matters which are exhaled by animals and
vegetables. Some of them are perfectly characteristic
of the beings from which they are derived. Thus the
odors of the musk-deer, of the goat, of certain reptiles, and
many other animals, and of an immense number of plants,
belong to this class. It is highly probable that every
animal and vegetable has its own peculiar smell.

Many vegetable emanations are deleterious to health,
and serious consequences, and even death have resulted
from them. The volatile principle which escapes from the
Rhus toxicodendron or poison-vine causes, in some persons,

NON-ESSENTIAL CONSTITUENTS OF THE ATMOSPHERE. 167

a violent erysipelatous inflammation of those parts of the
skin exposed to its action; and death has been known to
ensue from sleeping in a room in which highly odoriferous
flowers were placed.

The emanations from the human body are of a decidedly
deleterious character when present in large amount in the
atmosphere inhaled. Their exact nature has not been
satisfactorily ascertained, but enough has been established
to show that they consist of various principles derived from
the articles taken as food or the products of the destruc-
tive metamorphosis going on in the blood and tissues.
Any matter of a volatile nature accidentally present in the
blood, is also given off both by the skin and lungs. If a
small quantity of turpentine, for instance, be injected into
the blood, of a dog, it is immediately detected in the pro-
ducts of respiration. Persons who have been subjected to
the anaesthetic influence of ether or chloroform exhale
these 'substances through the medium of the expired air
and the perspiration for several hours afterward.

That the ordinary exhalation from the lungs contains
organic matter, can very readily be ascertained by causing
the expired air to pass through pure colorless sulphuric
acid, as was done by Valentin and Brunner. Through
the carbonization of the organic particles the sulphuric
acid becomes of a very perceptibly brown color. Perman-
ganate of potassa in solution indicates, with great exacti-
tude, the presence of organic matters in the products of

respiration.

That such substances are also present in the sweat, does
not admit of a particle of doubt, as they are rendered sen-
sible by the odor. They are frequently oleaginous and
acid. I have collected the water given off by the lungs
and skin and have always found it to contain organic
matter, as indicated by the solution of permanganate of
potassa. Moreover, the fact that this water undergoes

168 A TREATISE ON HYGIENE.

putrefaction very readily, is another evidence that it con-
tains organic matter.

When we enter a room in which many persons are con-
tained we are at once struck by the oppressive character of
the air. That this is not altogether due to the presence
of carbonic acid, is very apparent from the peculiar odor
which is evolved. The same is true of a chamber in which
any one has slept, and which has not yet been purified by
ventilation, or of the bed which has been lain in.

That these organic emanations are hurtful, has already
been asserted. The proofs are ample, and are derived
from direct experience and experiment. Witness the case
already referred to of the . Englishmen confined in the
Black Hole at Calcutta, and in which the peculiar odor of
the air was distinctly noted by the narrator. The symp-
toms preceding death were altogether unlike those at-
tendant on a mere deprivation of oxygen. Take also the
instance of the passengers on board the steamship London-
derry, who were confined, to the number of one hundred
and fifty, in a small cabin for several hours, and in which
the cases of death, amounting to seventy, were clearly not
due to asphyxia. Many others might be brought forward,
all of which illustrate the point contended for.

Moreover, disease is produced by the concentrated or-
ganic emanations from the bodies of those who have been
confined in close and ill-ventilated places. Bacon* alluded
to this fact nearly three hundred years ago, when he said
that "the most pernicious infection, next the plague, is the
smell of the jail when the prisoners have been long, and
close, and nastily kept, whereof we have had in our time
experience twice or thrice when both the judges that sat
upon the jail, and numbers of those who attended upon
the business, or were present, sickened and died. There-

* Natural History, Experiment dccccxiv.

NON-ESSENTIAL CONSTITUENTS OF THE ATMOSPHERE. 169

fore it were good wisdom that in such cases the jail were
aired before they were brought forth."

In the year 1577 typhus fever was produced at Oxford
to such an extent, by the effluvia arising from prisoners
brought into court to be tried, that over five hundred
deaths occurred in consequence.

On the 11th of May, 1750, the sessions began at the Old
Bailey, in London. About one hundred prisoners were
tried, and while the trials were progressing, the prisoners
immediately before the court were detained in two rooms
opening into the court-room, each fourteen feet long by
eleven in width, and seven feet high, equal to 1678 cubic
feet, which, if we allow that there were fifty persons con-
fined in each, would give but twenty-one and a half cubic
feet per man. The court-room itself was but thirty feet
square. It is very easy to conceive the condition of the
miserable wretches subjected to this treatment, and the
concentrated character of the emanations which they took
with them in their clothes to the court-room, and which
were given off among the people assembled there, who
themselves added to the noxious effluvia. In consequence
of this criminal violation of the laws of hygiene many in-
dividuals sickened and died, among them four judges, and
several counsellors, sheriffs, jurymen, and others present,
to the number of forty, without counting those whose con-
dition in life was such that they went unnoticed*

Many other cases might be brought forward similar to
the above. So frequent were they in England, before en-
lightened views began to prevail, that sessions of courts,
leading to the development and spread of typhus fever,
received the specific designation of "black assizes;" such
were the black assize at Exeter in 1586, that at Taunton,
and others. ^

"♦Tee Pringle's Observations on Diseases of the Army, edited by
Rush, p. 290.

170

A TREATISE ON HYGIENE.

In addition to evidence like that referred to, relative to
the poisonous character of the organic emanations from the
human body, we have the proof derived from direct experi-
ment. M. Gavarret subjected animals to an atmosphere
contaminated with animal exhalations, and though he
restored the oxygen as fast as it was removed, and drew
off the carbonic acid as rapidly as it was formed, he found
that the animals submitted to investigation perished.

My own experiments are to the same point. I confined
a mouse in a large jar, in which were suspended several

Fig. 10.

sponges saturated with baryta-water. By this means the
carbonic acid was removed as fast as formed, as was proven
by the fact that on causing a portion of the air in the bell-
glass to pass through baryta-water no carbonate of baryta,
beyond a very small quantity, was formed. Fresh air was
supplied as fast as it was required by means of a tube com-
municating with the bell-glass and closed by a little water

NON-ESSENTIAL CONSTITUENTS OF THE ATMOSPHERE. 171

in the bend of the tube, which acted as a valve. As the
air in the bell-glass was rarefied by respiration and the
absorption of the carbonic acid, fresh air flowed in from,
without, while the arrangement of the tube prevented the
air of the bell-glass from passing out. The watery vapor
exhaled by the animal was absorbed by two or three small
pieces of chloride of calcium. The whole arrangement is
shown in Fig. 10.

The mouse subjected to this experiment died in forty-
five minutes. The observation was repeated many times,
and death invariably ensued in less than an hour. On
causing the vitiated air to pass through a solution of per-
manganate of potassa, the presence of organic matters, in
large quantity, was at once demonstrated.

There can be no doubt, therefore, that the organic ema-
nations from the bodies of man and other animals, in a
condition of comparative health, are positively noxious,
and that too much care cannot be taken to rid our habita-
tions of them. When persons not in sound health are
crowded together, we can at once perceive that the ex-
halations given off from their bodies are possessed of still
greater deleterious properties, and hence the increased
necessity which exists for purifying the sick chamber and
the wards of hospitals. The exhalations in question cling
to the clothing, the furniture, the walls, and especially the
bedding. These facts are not new ; Trotter,* who wrote
nearly seventy years ago, in speaking of Dr. Lind's re-
marks relative to the danger of catching fever from piles
of bedclothes and body linen, says: "The washerwomen of
Haslar have also told me the same thing. They know
when a dangerous fever is in the hospital from the bad
smell of the clothes; this makes them air them abroad
till the smell is gone, and then they can wash them with

* Medicina Nautica. London, 1797, p. 177.

172 A TREATISE ON HYGIENE.

safety. But if it happened from the hurry that this could
not be done, or if it was neglected by design, many of
them have been seized with the sickness. The porters
and people employed in cleaning and fumigating the blan^
kets and beds at Haslar are well acquainted with this fact,
and they measure the danger by the badness of the smell."
Many authors of still greater antiquity might also be cited
in regard to this point.

In relation to the disposition of the effluvia from
patients to be absorbed by the walls of the rooms in which
they are placed, the case of the ward in the City Hospital,
New York, is a striking instance. Hospital gangrene had
occurred in this ward, and though the patients were all
removed, together with the furniture, the disease attacked
other patients who were placed in it. The ward was then
closed for some time, the walls whitewashed, and the
whole room thoroughly cleansed and purified; yet when it
was again opened for the reception of patients, the disease
recurred. The plastering was next scraped off, and new
plaster put on the walls; but without avail, the hospital
gangrene attacking the inmates as before. It was not
until the entire walls were taken down and renewed that
the taint was removed.

Three years after the event stated as occurring at the
Old Bailey, five carpenters, who were engaged in making
the necessary alterations in Newgate, with the view of
more effective ventilation, were attacked with typhus
fever.*

For the detection of organic matter in the atmosphere,
the permanganate of potassa affords a very sensitive re-
agent. A solution of this substance in water loses its bril-
liant red color, and the salt undergoes decomposition when

* Adatns's Observations on Morbid Poisons, etc. London, 1807,
p. 330.

NON-ESSENTIAL CONSTITUENTS OF THE ATMOSPHERE. 173

air containing organic matter is passed through it. By the
extent to which the loss of color reaches we are enabled to
form an approximate idea of the amount of such matter
present in the air. The solution is placed in Liebig's
bulbs, and the air drawn through it by means of an aspi-
rator. When we come to the consideration of the atmos-
phere of hospitals, and the means of purifying them, this
whole subject will more fully engage our attention.

In addition to the gaseous emanations from plants and
animals, the atmosphere contains a vast quantity of organic
morphological matters; these consist of pollen, the spores
of fungi, starch granules, epithelium cells, pus cells, and
perhaps certain peculiar bodies, the existence of which is
as yet doubtful.

During the prevalence of the cholera in Great Britain in
1849 several observers announced the discovery, in the air,
of what was called the cholera cell. It was asserted that
large quantities of these cells were also found in the evacu-
ations of cholera patients. The existence of any such or-
ganism is generally denied at the present day. I have
frequently sought for it during the prevalence of cholera,
but always without success. That diseases may, however,
be communicated through the medium of the atmosphere
by organic forms suspended in it, is scarcely a subject for
doubt. Dr. Parkes* asserts that in the atmosphere of the
wards of Fort Pitt, epithelium cells have been detected in
several instances, and quotes Eiselt as authority for the
discovery of pus cells floating in the atmosphere of a
room in which were thirty-three children with purulent
ophthalmia.

Pasteurf found that all the animal and vegetable pro-

* Statistical, Medical, and Sanitary Reports of the British Army for

1860, p. 346.
f Comptes Rendus, February 6th and May 7th, 1860.

174

A TREATISE ON HYGIENE.

ductions which arose in sugared water, mixed with a little
albuminous material, were derived from the ova of infu-
soria, or the spores of mucedinea, floating in the atmos-
phere. Subsequently he extended his observations to milk
and wine with similar results.

Pouchet,* who has given very great attention to this
subject, though admitting the presence in the atmosphere of
starch granules, textile fibers, etc., denies that the ova of
infusoria or the spores of fungi are ever met with. While
agreeing with him relative to the great predominance of
starch granules, I am sure that I have discovered bodies
which presented all the characteristics of ova of infusoria,
and spores of cryptogamic plants. The instrument made
use of in the examinations did not vary materially from
that employed by Pouchet. It consisted of a glass tube,
two inches in diameter, closed at each end by a well-fitting
cork. One of these corks was perforated so as to receive

Fig. 11.

the pointed extremity of a small copper funnel, the other
was connected with an aspirator. The apparatus is shown
in the accompanying cut. (Fig. 11.) Into the large tube a

* Comptes Rendus, April, 1860.

NON-ESSENTIAL CONSTITUENTS OF THE ATMOSPHERE. 175

square piece of glass was introduced, and placed at the dis-
tance of about the one-twelfth of an inch from the ex-
tremity of the copper funnel. When the aspirator was
set in action by opening the stop-cock, the air entered the
funnel and impinged upon the glass plate, where it de-
posited its morphological constituents. After an hour or
two the plate was removed, and submitted to microscopical
examination. Frequently I obtained the spores of penicil-
lium and of other mucedines, and occasionally dried infu-
soria of the more common varieties. The air of hospitals,
which I have extensively examined with reference to its
containing organic forms, will be more appropriately con-
sidered under another head.

Many diseases have been ascribed to a cryptogamic ori-
gin, and with very considerable appearance of truth. Prof.
J. K. Mitchell held the opinion that malaria owes its
essential characteristics in the production of disease to the
spores of fungi inhaled into the lungs. I was myself
several years since attacked with an intermittent fever
after inspecting a large quantity of musty hay belonging
to the government. The coincidence may have been acci-
dental, but it is certainly striking when taken in connec-
tion with the facts brought forward by Dr. Mitchell.

Aqueous Vapor. — The atmosphere always contains a
certain amount of water in the state of vapor, varying in
quantity according to the temperature and density of the
air, the season, the latitude, the situation, the altitude, etc.

The water in the atmosphere is derived by evaporation
from the oceans, lakes, and rivers of the earth. A current
of air saturated with vapor at its temperature rises from
the earth, and meeting with other currents of lower tem-
perature, loses its vapor, which is condensed into watery
particles; these fall to the earth again as rain, hail, or
snow, according to the temperature of the strata through
which they pass.

176 A TREATISE ON HYGIENE.

The relative amount of vapor in the atmosphere is as-
certained by determining the dew-point. This is readily
done by placing a little water in a polished metal cup, in-
serting a delicate thermometer in it, and dropping in small
pieces of ice till a slight moisture is deposited upon the
outside of the vessel. The point at which the mercury
stands in the thermometer gives the temperature of the
dew-point, that is, the temperature to which the atmos-
phere requires to be reduced in order that its vapor should
be deposited as water.

Various instruments, called hygrometers, are used for the
purpose of ascertaining the dew-point. None of these are
very exact. Many simply measure the relative degree of
humidity, others require great care in their management,
and a troublesome calculation, before the dew-point can be
found. The one used in the army is Mason's. It consists
of two thermometers, one of which is covered with a piece
of muslin or silk, which is kept moist by capillary attrac-
tion of water from a reservoir. As evaporation progresses
from the wet bulb, the temperature falls, and when it
becomes stationary, it is read off and compared with that
indicated by the other thermometer. By a mathematical
formula, (that of M. Regnault being considered the most
reliable,) the dew-point is ascertained. Tables for simpli-
fying the process are found in all works on meteorology,
and in the directions issued by the medical department of
the army.

The amount of vapor in the atmosphere exercises a very
important influence upon certain physiological processes.
Thus, the quantity of perspiration and of aqueous vapor
given off by the lungs is much less when the atmosphere is
loaded with moisture than when it is dry. On the con-
trary, the quantity of urine excreted is greater in dry than
in damp weather, for then the watery particles are given
off in greater amount by the emunctories of the skin and

NON-ESSENTIAL CONSTITUENTS OF THE ATMOSPHERE. 177

lungs. Edwards* found that air saturated with moisture
did not prevent perspiration, though it reduced it to its
minimum ; and that in dry air the perspiration was from
five to ten times greater than in air of extreme humidity.
I have repeated his experiments, and with analogous
results.

The consideration of the degree of moisture of the atmos-
phere should be accompanied by that of the temperature.
Air that is very moist and warm is debilitating and relax-
ing in its action, at the same time that it depresses the
nervous system. Under the long-continued operation of a
humid and warm atmosphere, the phlegmatic temperament
is developed to its utmost point, and a tendency to obesity
established.

Such an atmosphere is also injurious, from the fact that
it is extremely favorable to the decomposition of the organic
matter which is contained in the air, and to the consequent
production of disease. As Huxhanrf says: "A moist,
warm xazdoatnc; of the atmosphere relaxes the fibers too
much, enervates the power of the vessels, renders the
blood of too loose a texture, too glutinous and inert, and
makes the whole body dull, unstrung, and languid, and
exposed to long, slow, putrid, intermitting fevers. * *
But very often, indeed, while such kind of weather lasts,
quotidians and tertians are apt to degenerate into long-con-
tinued putrid fevers, and that to the no small danger of the
sick; who, if they happen to recover from them, generally
fall, in the conclusion, into a jaundice or dropsy. The sick
persons, indeed, never recover sooner or more happily than
in fair, bright weather, and when the mercury stands high
in the barometer. This I have myself constantly observed,

* On the Influence of Physical Agents on Life. English translation,

p. 35 and 71.
•j- Observati(
vii. (Preface.)

pp. 35 and 71. .. en

f Observations on the Air and Epidemic Diseases. London, 1767, p.

178 A TREATISE ON HYGIENE.

and the very famous Fred. Hoffman (long conversant in
the practice of physic) remarked the same very long since;
whereas, when a cloudy, rainy, southerly wind blows, they
recover exceeding slowly."

In certain diseases, such as those affecting the pulmonary
mucous membrane and the parenchyma of the lungs, a
moist atmosphere, unaccompanied by too high a tempera-
ture, is beneficial.

A damp and cold atmosphere gives rise to inflammations,
especially of the mucous membrane of the respiratory pas-
sage, to rheumatism, and to diarrhoea and dysentery.
These effects are probably produced through its influence
in lowering the temperature of the body, and in checking
the excretion from the skin. A feeling of oppression and
uneasiness is thus caused, which is perfectly characteristic.
During such a condition of the atmosphere, troops in the
field are rendered more liable to scurvy and to typhoid and
typhus fevers. Epidemic diseases of all kinds prevail with
far more intensity at such times. The mortality from all
causes of disease is much greater during the prevalence of
the combination of excessive moisture with a low tempera-
ture, than at any other period.

Dryness, conjoined with a high temperature, is not favor-
able to health. The loss by the skin and lungs is, under
such circumstances, greater than at any other time, and,
after a long continuance of a dry and hot atmosphere, it
will generally be found that the body has very perceptibly
lost weight. The experiments of Edwards, to which refer-
ence has already been made, are conclusive on this point,
and I have been able to confirm them in all essential par-
ticulars.

A dry and cold atmosphere cannot be regarded as preju-
dicial to health. Its effects upon the organism are generally
of a most exhilarating character. The secretions and ex-
cretions are effected with ease, and the balance between

NON-ESSENTIAL CONSTITUENTS OF THE ATMOSPHERE. 179

them is well established. This combination is more usually
met with in elevated situations.

Under the head of Temperature, we shall consider, more
at length, the influence of heat and cold upon the human
system.

In the next place, we might proceed to consider the
various effluvia which are given off by manufactories, and
which exercise such deleterious effects upon the vegetation
and inhabitants subject to their influence; but this would
lead us into the discussion of subjects which, though of
great importance, do not come within the scope of this
treatise. Some of these noxious vapors will be alluded to
more at length under another head.

Malaria. — The most important subject to be considered
under the head of accidental constituents of the atmosphere
is malaria. After centuries of observation, however, we
appear to have made little if any progress toward ascer-
taining its composition, though the laws by which it is
governed have come to be tolerably well understood, and
we are, in consequence, enabled to protect ourselves against
its effects.

Two theories relative to its nature especially claim at-
tention. According to one, (which is far the older, having
been definitely promulgated by Lancisi in 1695,) malaria is
constituted of gaseous emanations from the decomposition
of vegetable matter, through the action of heat and moist-
ure. The other ascribes it to the presence of poisonous
fungi in the atmosphere, sufficiently minute to be wafted
about by the motion of the air, and acting upon the organ-
ism through the medium of the function of respiration.
This theory was advanced by the late Prof. J. K. Mitchell,
and sustained in a course of lectures* which he delivered

* On the Cryptogamous Origin of Malarious and Epidemic Fevers.
Philadelphia, 1849.

180 A TREATISE ON HYGIENE.

several years since in the Jefferson Medical College of Phil-
adelphia.

In regard to the first-named hypothesis, the facts that
malarious diseases occur where there is no vegetable decom-
position, as on the banks of the Tagus opposite Lisbon, the
sandy plains of New Mexico, where there is no rain and
scarcely any vegetation, and that in many localities where
there are vegetable decomposition, heat, and moisture,
there are no malarious affections, are difficult if not impos-
sible of being reconciled with the truth of the theory in
question. . Many other arguments might be adduced against
it; so that, while it is true that malaria is generally pro-
duced in greatest abundance where heat and moisture are
conjoined with vegetable decomposition, no necessary rela-
tion between them and this morbific agent has been estab-
lished.

The theory proposed by Dr. Mitchell appears to me, on
many accounts, more plausible ; both from what was pre-
viously known relative to the poisonous character of certain
fungi, and from the facts and arguments he has brought
forward in its support. In addition, I have myself noticed
several circumstances which appeared to favor it ; not the
least of which was the occurrence of immense quantities ol
the spores of fungi in the atmosphere of malarious localities.

If the apparatus figured on page 174 be set in action in
a region where malaria is evolved, it will be found that, on
submitting the glass plate to microscopical examination,
numerous spores of fungi have been deposited. Among
them the bassidiospores of hymenomycetous and gastero-
mycetous fungi will generally be found predominant.

I have already referred to the instance in which I con-
tracted an intermittent fever from (so far as I could deter-
mine) inspecting a large lot of damaged hay, and I have
frequently suffered from headache, with febrile action, after
rummaging among old books which had become musty from
long disuse.

NON-ESSENTIAL CONSTITUENTS OF THE ATMOSPHERE. 181

Instances of the poisonous action of certain fungi are
exceedingly common. In fact, the great majority of them
are far from being inert in their action on the animal
economy. When the active principle is absorbed into the
system, it is difficult of elimination, and, even when ex-
creted, is found still to possess its poisonous properties.
These facts are well marked in the aminita muscaria, the
intoxicating fungus in use by the Tartars of the north-
eastern parts of Asia. The active principle, instead of
being destroyed, is eliminated by the kidneys unchanged;
so that those who make use of it as an intoxicating agent,
are enabled to obtain its full effect by drinking their urine
passed after a debauch. There appears to be no limit to
this propagation through the urine of the poisonous quali-
ties of the aminita, for they may be passed in this way
from one person to another, without diminution in activity.
Some years since, Dr. B. W. Richardson* published an
article on the narcotic and anaesthetic properties of the
Lycoperdan proteus, or common puff-ball, as developed in the
smoke given off by this fungus in burning. Subsequently,
Mr. T. J. Herapathf very decidedly proved that the poison-
ous principle evolved by the combustion of the lycoperdon
was carbonic oxide. Latterly I have caused animals to
inhale the spores of the fungus in question, and have inva-
riably found narcotism and anaesthesia produced. In my
own person, even when inhaled to a very small extent, a
drowsy feeling was always caused. Animals subjected to
the influence for any considerable length of time after the
induction of coma, invariably died in a comatose condition.
On examination after death, the spores were found in the
bronchi, stomach, and intestines.

But perhaps the most striking instance of the morbific

* Medical Times and Gazette, 1853, p. 160.
f Chemist, vol. ii. 1855, p. T61.

182 A TREATISE ON HYGIENE.

influence of the fungi is exhibited by the fact, almost cer-
tainly established, that they are the cause of "camp
measles." The researches and experiments of Dr. Salis-
bury,* of Ohio-, leave scarcely a doubt on the subject, and
constitute a most important addition to our knowledge of
the etiology of diseases. Since the commencement of the
present rebellion, the troops in camp have suffered to a
great extent from measles. I have seen regiments with
half their men on the sick report from this cause. The
origin of the disease was a mystery. Men leaving their
homes in perfect health, would go into camp, and be soon
after attacked. Dr. Salisbury, after becoming acquainted
with several instances in which a disease not distinguish-
able from measles had been contracted after the individuals
had handled or been in contact with straw in a state of
partial decomposition, was led to examine, microscopically,
the fungous growths which attach themselves to wheat
straw in a mouldy condition. He gives minute descriptions
of the spores and cells of these structures.

With a devotion to science, in the highest degree credit-
able, Dr. Salisbury inoculated himself with the fungi, and
succeeded in producing a disease characterized with all the
phenomena of measles. His wife, also, with no Jess he-
roism, allowed herself to be inoculated, with similar results.
Other instances are given, all to the same general effect.

On examination of the straw used by the troops at Camp
Sherman for bedding, it was found covered with fungous
growths of the same kind as those used for the inoculations.
Measles was then very prevalent in this camp.

Dr. Salisburyf mentions other facts bearing on this point,
in a paper subsequently published, in which the details of
the inoculation of twenty-seven persons with the straw fun-

* American Journal of the Medical Sciences, July, 1862.
f Ibid., October, 1862.

NON-ESSENTIAL CONSTITUENTS OF THE ATMOSPHERE. 183

gus, in addition to those previously performed, are given.
In all these cases the disease was produced and protec-
tion afforded against an epidemic of measles then raging.
It would be difficult to present a stronger instance of the
relation between cause and effect than that which forms
the subject of his memoirs. I am able entirely to confirm
his observations relative to the existence of the fungi he
describes on moist straw. I have very little doubt that
many other diseases will be found to be produced by a like
cause. It is highly probable that "hay asthma" is one of
these, and I design experimenting on this point as soon as
an occasion offers.

The very rapid growth of the fungi is strongly confirm-
atory of the plausibility of Dr. Mitchell's theory. Thus,
Fries counted more than ten millions of sporules in a single
specimen of Reticularia maxima; and the Bovista giganteum
has been known to increase in a single night from a mere
point to the size of a large gourd. After a rain, it will fre-
quently be found in certain localities that the ground is
covered with fungi two or three inches in height, the
growth of a single night.

The fact, too, that the fungi grow almost entirely at
night, is in strict harmony with the circumstance of the
almost exclusive activity of malaria at this time.

Many other strong coincidences might be brought for-
ward; but they are only coincidences, and simply give
great probability to the theory under consideration without
actually establishing its correctness. This will only be done
when it is known that malarious diseases are caused by
the inhalation of fungi or their spores, and by no other
agency.

No subject connected with hygiene is of greater import-
ance than the full understanding of the laws by which ma-
laria is governed, and these we propose now to consider.

1st. Malaria is more potent in the immediate vicinity of

184 A TREATISE OX HYGIENE.

its place of origin than at even a short distance from its
source.

Thus, the individuals living on the bank of a river or
border of a marsh, from which malaria is given off, are
always more subject to fevers than those situated a short
distance from such localities. This fact was very well
marked at Fort Meade, in Florida, where I was stationed
several years since. The barracks were originally built on
the bank of Pease Creek, a small sluggish stream flowing
through a thickly-wooded bottom. Intermittent and remit-
tent fevers made such sad havoc among the troops, that
new barracks were constructed about half a mile from the
first location. The change was productive of the best re-
sults ; for, though fevers were by no means prevented, they
were very much lessened, both in frequency and severity.
Numerous instances of the operation of this law must be
familiar to every reader.

2d. Malaria is more active in low than in elevated situa-
tions.

This was very clearly perceived at Fort Riley, in Kansas,
which is situated on a bluff overlooking a low alluvial
region, through which the Kansas River runs. One quarter
of the barracks is not more than two hundred yards distant
from the former bed of the river, which is now covered
with a luxuriant growth of cotton-Avood, and which is rich
in malarious emanations. The laborers, who had their
huts in this locality, were exceedingly subject to intermit-
tent and remittent fevers, while the soldiers, who lived on
the hill, were rarely affected. Indeed, these diseases were
entirely confined to those who either lived altogether in
the low lands, or worked in them the greater part of the day.

The instance referred to by Dr. Ferguson is still more to
the point. The British garrison at English Harbor, in
Antigua, occupied, in 1816, three sets of barracks. One of
them was situated on Monk's Hill, six hundred feet above

NON-ESSENTIAL CONSTITUENTS OF THE ATMOSPHERE. 185

the marshes, which evolved a most intense malaria. The
others were situated on a height called the Ridge, one five
hundred feet, and the other three hundred feet above the
marshes. Those officers, soldiers, women, and children
who lived in the barracks on Monk's Hill had no fever of
any kind ; those who inhabited the barracks on the Ridge
at five hundred feet, were scarcely affected ; those who were
quartered in the barracks at three hundred feet, had remit-
tent fever; while those who had to stand night guard at
the marshes, were frequently attacked with violent delirium
at their posts, and died within thirty-six hours, with yellow
skin and black vomit.

Rigaud de l'lsle,* in speaking of the malaria of Italy,
says : —

" Let us suppose an observer placed upon the coast ; he
considers the inhabitants; he sees them in summer, and
more particularly in autumn, with a livid tint, shining
skin, the abdomen distended, a lounging, listless gait,
mostly afflicted with putrid and malignant fevers. He
directs his course to one of those elevated rocks which I
have described; he ascends, and as he rises, he finds no
other fever than the simple intermittent ; by degrees this
also disappears ; he meets with no faces but what exhibit
a ruddy glow, and all the appearances of health and vigor.

" Which way soever he turns, the same phenomena pre-
sent themselves; in every quarter diseases pursue the in-
habitants of the plain, and spare those of lofty mountains;
hence he cannot help inferring that the bad air does not
rise so high as the latter, and that it must therefore possess
a greater specific gravity than the ordinary atmospheric

air."

The Pontine Marshes are noted for the highly concen-

* Influence of Tropical Climates on European Constitutions, etc., by
James Johnson, M.D., etc., vol. ii. Philadelphia, 1821, p. 111.

186 A TREATISE ON HYGIENE.

trated malaria which arises from them. Sezza is nine hun-
dred and eighteen feet above their level, and the inhabit-
ants are altogether free from malarious diseases.

It is to be understood that what has been said applies to
height relatively, not absolutely. There are many instances
of malaria being given off from localities situated at very
considerable heights above the level of the sea. Thus, the
Pueblo village of Laguna, in New Mexico, has an altitude
of over 5000 feet, and yet it is very subject to intermittent
fever, produced by the malaria evolved from a marsh in the
immediate vicinity, at a very little less elevation. Hum-
boldt* and other travelers mention several examples of a
similar kind.

Even the difference in elevation between the first and
second floors of a dwelling is important, those living in
the higher stories being much less liable to malarious
diseases.

3d. Malaria is very much more noxious during the night
than the day. The greatest degree of activity appears to
be manifested at about the time of the rising and setting of
the sun.

I have witnessed many examples of the correctness of
these propositions. Their truth is familiar to all observers,
and especially to the inhabitants of malarious localities.
Thus, to pass through the Pontine Marshes after sunset is
almost certain death; while in the daytime little danger
is encountered. Many instances have occurred of travelers
contracting fevers, resulting in death, from a neglect of
proper precautions in this respect.

Lindf insists, with great force, on the danger incurred
by passing the night in unhealthy localities. After men-

* Essai Politique sur la Nouvelle Espagne.

f An Essay on the Diseases incidental to Europeans in Hot Climates,
etc. London, 1778, p. 215.

NON-ESSENTIAL CONSTITUENTS OF THE ATMOSPHERE. 187

tioning other instances, he relates that of the Phcenix ship-
of-war, which is so much to the point that I quote his
remarks in full.

" In a voyage to the coast of Guinea, performed in the
year 1776, by the Phoenix ship-of-war of forty guns, the
officers and ship's company were perfectly healthy till, on
their return home, they touched at the Island of St.
Thomas. Here the captain unfortunately went on shore
to spend a few days in a house belonging to the Portuguese
governor of that island. This happened during the rainy,
or sickly season. In the same house were lodged the cap-
tain's brother, the surgeon of the ship, some midshipmen,
and the captain's servant. But, in a few days after their
being on shore, the captain, his brother, the surgeon, and
every one, to the number of seven, who had slept in that
house, were taken ill, and all of them died except one, who
returned to England in a very ill state of health. The
ship lay at anchor there twenty-seven days; during which
time three midshipmen, five men, and a boy remained on
shore for twelve nights to guard the water-casks, under
pretence that the islanders would steal them. At that
island only those who slept on shore were taken ill, and
no other man of the ship's company was seized with any
distemper during their stay there, or during the voyage.
If we except these unfortunate persons, only one man died
through the whole of that time, and he was killed by an
accidental blow on the head.

" None of those who slept on shore escaped the sickness,
and of them, only three survived it: one midshipman, who
has ever since been in a cachectic state, for which he was
a patient in Haslar Hospital; a seaman in the same condi-
tion who has been twice under my care; and a mulatto,
one of the captain's cooks.

" While the Phoenix continued in this place, twenty or
thirty of her men went daily on shore; some rambled

188 A TREATISE ON HYGIENE.

about the island, hunting and shooting, others were busy
in bartering for provisions, washing linen, and other neces-
sary employments, so that almost all that ship's company,
consisting of two hundred and eighty men, were, in their
turns, ashore upon the island in the daytime, not one of
whom who returned to the ship at night were taken ill or
suffered the slightest indisposition."

Sir Gilbert Blane* also lays great stress on the point
that the men employed in getting water and wood should
so manage as not on any account to stay on shore all
night.

I have always noticed, when being in malarious districts,
that the men on guard during the night were much more
liable to attacks of fever than those who remained in their
quarters. Generally the disease appeared within twenty-
four hours after the exposure. The same fact was appa-
rent in the Peninsula during General McClellan's recent
campaign.

4th. Malaria is capable of being moved by the wind
from the places where it is formed to others which are
healthy in themselves.

Lancisrf- relates an incident which well illustrates this
property. A party of thirty ladies and gentlemen were
sailing on the Tiber, when the wind suddenly changed, so
as to bring 'toward them the malarious emanations from a
marsh in the neighborhood. Twenty-nine of the party
were immediately attacked with fever.

There is scarcely a locality where malaria is produced in
which the influence of the prevailing wind is not distinctly
perceived. I have noticed very many instances of this
fact, which is perfectly apparent to the dwellers in such

* Observations on the Diseases of Seamen. London, 1800, third
edition, p. 201.

| De Noxiis Paludum Effluviis. Roma, IT IT, p. 29.

NON-ESSENTIAL CONSTITUENTS OF THE ATMOSPHERE. 189

regions. Blane,* in considering the noxious effect of land
air, says : —

"I have known a hundred yards in a road make a dif-
ference in the health of a ship at anchor, by her being
under the lea of marshes in one situation and not in
another. Where people at land are so situated as not to
be exposed to the air of woods and marshes, but only to
the sea air, they are equally healthy as at sea. There
was a remarkable instance of this on a small island, called
Pigeon Island, formerly described, where forty men were
employed in making a battery, and they were there from
June to December, which includes the most unhealthy
time of the year, without a man dying and with very little
sickness among them, though they worked hard, lived on
salt provisions, and had their habitations entirely destroyed
by the hurricane. During this time near one-half of the
garrison of St. Lucia died, though in circumstances similar
in every respect except the air of the place, which blew
from woods and marshes."

Winds are useful in removing malaria from places in
which it has accumulated. I have several times found
that localities which immediately before heavy winds were
very unhealthy became much less so afterward, doubtless
in consequence of the dispersion of the noxious emanations.
5th. Malaria exhibits a great affinity for water.
This is a very interesting and important fact, for on it
depends the exemption from malarious disease enjoyed by
those of the crews of ships who stay on board their vessels.
This property of water to absorb malaria is undoubted,
and has been referred to by almost every writer on the
subject. Sir Gilbert Blane, Sir John Prmgle and others
notice it. A situation even to leeward of a focus of ma-
laria will suffer comparatively little from f evers if a sheet

* Op. cit., p. 205.

13 •

190 A TREATISE ON HYGIENE.

of water intervenes. I have noticed several instances of
this immunity. One reason, doubtless, why the night and
early morning air is so prejudicial to health in malarious
districts is that at such times the atmosphere contains
more moisture, and consequently is loaded to a greater
extent with malaria.

So strong is this attraction of malaria for water that
instances have occurred in which fevers have been pro-
duced by drinking the water of marshes. The case re-
corded by M. Boudin, and quoted by Watson and Levy,
admits of no other interpretation. "In July, 1834, three
hundred soldiers, all in good health, embarked on the same
day in three transports at Bona and arrived together at
Marseilles. They were exposed to the same atmospheric
influences, and, with one essential difference, supplied with
the same food and subjected to the same discipline. On
board one of the vessels were one hundred and twenty
soldiers; of these thirteen died of a destructive fever during
the voyage, and eighty-eight more were taken to the mili-
tary hospital of the lazaretto at Marseilles, presenting all
the pathological characters proper to marshy situations.
It appeared, upon inquiry, that the water furnished to the
soldiers on board the affected ship had been taken, in the
hurry of embarkation, from a marshy place near Bona,
while the crew, not one of whom were attacked, were fur-
nished with wholesome water. It was further ascertained
that the nineteen soldiers who escaped the disease had
purchased water from the crew, and had not partaken of
the marsh water. Not a single soldier or sailor suffered
in the other transports, which were supplied with pure
water."

The water used by the troops during General McClel-
lan's campaign in the Peninsula was derived from marshes,
and doubtless contributed its full share to the production
of the malarious fevers by which they were affected.

NON-ESSENTIAL CONSTITUENTS OF THE ATMOSPHERE. 191

6th. Malaria has also an attraction for trees and other
organic materials.

It is found perfectly practicable to prevent the access of
malaria to dwellings by planting large trees or thick shrub-
bery in the immediate vicinity, between the originating
point of the malaria and the house to be protected.

Musquito-nets fastened over the doors and windows at
night, when through the extreme heat these are left open,
also obstruct the malaria.

It has often happened that places previously healthy
have been rendered subject to malarious affections by
cutting down trees which interposed between them and
marshes.

Rigaud de l'Isle* states that in consequence of the felling
of the wood before Asterna, near the Pontine Marshes, Vel-
letri was visited for three successive years by diseases,
which made much greater havoc than usaal throughout
the whole country, and penetrated to many places which
they had not previously been accustomed to reach. He
says he has seen fishermen, who had built their huts near
the canal which runs from Campo Salino to the sea, pro-
tected entirely from diseases of malarious origin by a wood,
which screened them from the infected air of that morass.
7th. The first turning up of the soil leads to the pro-
duction of malaria, but continued cultivation causes it to
diminish in violence.

These facts are well understood in the West, and I have
seen many instances of these truths. Habitations which
have been healthy have become subject to malarious ema-
nations immediately after breaking the sod of the prairie
surrounding them. As the working of the land proceeded
from year to year, they regained their previous healthy
condition.

* Op. cit., vol. ii. p. 122.

192 A TREATISE ON HYGIENE.

8th. As has been already intimated, malaria shows a
marked proclivity to attack the members of the Caucasian
race in preference to the individuals of other races, and
therefore it is not necessary to dwell upon this point now,
further than to urge the employment of negroes in those
military field-labors which are attended with exposure to
malarious effluvia.

9th. Malaria is prevented, in a great measure, from ex-
ercising its deleterious influence, by fires.

Cities have been rendered healthy for a season by con-
flagrations occurring within their limits; and men exposed
to the night air in malarious regions make themselves
secure from its influence by building large fires around
their tents or bivouacs. I have often availed myself of
this means of protection.

10th. Malarious diseases may be prevented by the ad-
ministration of small quantities of quinine to those liable
to contract them.

Sir Gilbert Blane* mentions this prophylactic influence
of Peruvian bark, and urges the use of this medicine by
those exposed to malaria.

Prof. W. H. Van Buren,f in an important paper, which
deserves the widest circulation among our troops, for the
good it is capable of effecting, enters at length into the
consideration of this question. He says: "In April, 1840,
the writer, then an assistant surgeon in the United States
Army, was detached from the staff of the late General
Worth at Tampa Bay, Florida, for duty at a military post
in the interior, (Fort King,) where a serious outbreak of
miasmatic disease had just occurred. The stock of quinine
on hand was limited, and the supply uncertain, and every

* Op. cit, p. 209.

f Report of a Committee appointed, by Resolution of the Sanitary
Commission, to prepare a Paper on the Use of Quinine as a Prophylactic
against Malarious Diseases.

NON-ESSENTIAL CONSTITUENTS OF THE ATMOSPHERE. 193

man at the post was having his turn of disease. To meet
the emergency a quantity of quinine bitters was made in
the following manner : the half of a barrel of whisky was
drawn off into a second barrel, and they were both filled with
the bark of the dog-wood and wild-cherry, obtained from
the neighboring hummock, and dried in the sun. A few
ounces of quinine were added to each barrel, with the dried
peel of a dozen native oranges. From one to two ounces
of this preparation were given to each man at the post,
morning and evening, with the effect in a very short time
of rendering the relapses of fever less frequent and milder
in their character, lengthening the interval between the
attacks, and in many instances preventing their occurrence
entirely during its use."

I have frequently employed quinine with this object,
and always with success. Throughout the unhealthy
season of 1862 the troops generally, serving in malarious
regions, were supplied by the medical department with a
bitters made by dissolving quinine in whisky. The sul-
phate of cinchonia was finally substituted for the quinine
with excellent results.

From this cursory statement of the laws and habits
which influence malaria, it will be seen that to a very
considerable extent we are enabled to provide against its
ravages. Those having the control of troops should be
instructed by the medical officers of the command in the
knowledge of these matters, by attention to which sickness
may often be prevented, and the efficiency of the army
preserved. .

Thus troops should be quartered or encamped as far as
possible from the source of malaria.

Low situations should be avoided; barracks should be
built with the first floor raised some distance above the
ground and tents in permanent encampments should be
floored.

194 A TREATISE ON HYGIENE.

The night air should be as far as possible avoided. The
men should not be called up, unnecessarily, before sunrise,
and drills before breakfast should be discarded.

Stations for camps or barracks should be selected with
reference to the prevailing winds, so as to be to the wind-
ward of all marshes or other sources of malaria.

If possible, stations should be selected so as to have an
intervening sheet of water between any malarious region
and the troops, and the dews of morning and evening
should be avoided. Advantage should also be taken of
the property of trees and other foliage to retain malaria.
Tents should always be supplied, if possible, and the men
should be instructed to close them at night when exposed
to miasmatic emanations.

Fires should be built throughout the camp, unless mili-
tary reasons prevent. This is a point of great importance.

Finally, troops subjected to the influence of malaria
should be supplied with quinine or cinchonia as a prophy-
lactic, in the dose of two grains of the former or four of the
latter daily.

This concludes what we have to say relative to the con-
stituents of the atmosphere and the extraneous matters
which are found in it. The student of hygiene will find
much in the whole subject requiring still further investi-
gation than has yet been given to it, and it is commended
to him for careful study and original research.

PHYSICAL PROPERTIES OF THE ATMOSPHERE. 195

CHAPTER III.

PHYSICAL PROPERTIES OF THE ATMOSPHERE.

There are still other points to be considered in connec-
tion with the atmosphere, which have an important bearing
upon the hygienic condition of mankind, and these are its
density, and the power it possesses of being put in motion,
whereby winds are produced.

Density. — By the invention of the barometer in 1643,
Torrecelli, a pupil of Galileo, demonstrated the weight of
the atmosphere. He found that by filling a glass tube
with mercury and inverting it over a cup containing the
same metal that the column was sustained at about thirty
inches in height. Subsequently Pascal ascertained that a
column of water, thirty-three feet in height, was also
supported by the pressure of the atmosphere.

At the level of the sea the atmosphere exerts a pressure
of nearly fifteen pounds to the square inch. As we ascend
from this level, the weight of the atmosphere becomes less,
and the mercury in the barometer progressively falls. On
the contrary, as we descend into mines, the mercury rises,
in consequence of the increased height and weight of the
atmosphere. Aside from altitude, there are other circum-
stances which increase or diminish the density of the
atmosphere. The barometer has been found to oscillate
with perfect regularity, according to the period of the day,
being higher in the morning and evening than the middle
of the day. These variations are especially marked in low
latitudes. As we approach the poles, they become less and
less extensive, until at 70° they are scarcely perceptible.

196 A TREATISE ON HYGIENE.

In addition to these daily regular oscillations, there are
others which are accidental — that is, dependent upon tran-
sient and uncertain causes. These are much more exten-
sive than the diurnal variations, which may be considered
as corresponding to the oceanic tides, while the others
represent storms. These last are much more extensive in
polar than in tropical regions. They are doubtless due, in
the main, to the condensation or rarefaction of the atmos-
phere, through the action of winds, and to the presence of
a greater or less amount of aqueous vapor.

The degree of density of the atmosphere is not without
considerable influence on the well-being of man. From
the experience of those who have ascended to great
heights we are enabled to form an idea of how important
it is to his existence that a certain amount of pressure
should be communicated to his body. Difficulty of breath-
ing, hemorrhages from the nose and mouth, vertigo, and
other alarming symptoms being produced in those who
have attained to great altitudes. At the same time the
influence of habit in this respect is very great, for we find
large cities situated at heights which could not be endured,
without some inconvenience, by those not accustomed to
them. The entire pressure of the atmosphere on the sur-
face of the human body, if we estimate the superficial area
of a full-grown man at two thousand square inches, is
about thirty thousand pounds at the level of the sea. For
every inch of depression of the barometer a thousand
pounds of pressure are removed from his body. Altitudes
have been reached by man at which the mercury in the
barometer stands at only thirteen inches, and consequently
seventeen thousand pounds weight are removed from his
body at such heights.

On descending to extreme depths in water, by means of
diving-bells as they were formerly constructed, the press-
ure of the contained atmosphere was very much increased.

PHYSICAL PROPERTIES OF THE ATMOSPHERE. 197

Blood has been known to flow from the lungs, nostrils, and
ears, and the tympanum of the ear has been ruptured.
Habit here also exerted its influence, and the greatly in-
creased density came to be borne by the workmen without
inconvenience. M. Triger,* in the course of some mining
operations, found it necessary to subject the workmen to a
pressure of about three atmospheres. Though pain and
inconvenience were felt at first, they soon became used to
the new state of things.

Although it is not probable that an increase in the den-
sity of the atmosphere, within the limits of the ordinary
range of the barometer, could seriously affect the hygienic
condition of man, there is strong reason for supposing that
this instrument is capable of affording valuable indications
relative to the presence of gases or vapors prejudicial to
health. Several years since Dr. Proutf noticed a small
but sensible increase in the weight of the air during the
prevalence of cholera. This continued for six weeks,
when circumstances occurred to suspend his observations.
Dr. Prout did not attribute the cholera to the mere in-
crease in the density of the atmosphere, but thought that
the barometer indicated the existence of a deleterious and
heavy gaseous element in the lower strata of the air.

Dr. R. D. Thomson J examined into the density of the
air in London during the prevalence of cholera, and ob-
tained results analogous to those arrived at by Dr. Prout.
He found that, as the mean of a number of observations,
the weight of a cubic foot of air in August, 1854, when
cholera prevailed, was 525-6 grains, whereas in August,
1855, when there was no cholera, it was 523'5 grains.

* Influence de l'Air eomprime sur la Sante. Ann. d'Hygiene, 1845,

tome xxxiii. p. 463.

f On the Influence of Physical Agents on Life, by W. F. Edwards,

M.D., F.R.S., etc., p. 220, note.

I On the Condition of the Atmosphere during Cholera. Chemist,

1856, vol. iii. p. 121.

198 A TREATISE ON HYGIENE.

I have had no opportunity of observing the density of
the atmosphere during the prevalence of cholera, as I was
without a barometer or other means for determining the
weight of the air, while the three epidemics of the disease,
which I have witnessed, lasted. From a careful search of
the meteorological records of the Surgeon-General's office, I
find that there was a very considerable rise in the barome-
ter, at the several posts and garrisons, while cholera was
prevailing in 1849, amounting to as much as 060 of an
inch when compared with the corresponding month of the
previous year, when there was no cholera. This increased
density was well marked in subsequent years when cholera
visited the military stations.

Winds. — The influence of winds upon health is very
great. Through the action of the almost constant cur-
rents, which are excited by the varying density of the
atmosphere, the air, which has become contaminated by
organic and other exhalations, is removed, to make way
for that which is fresh and contains the normal amount of
oxygen. Thus stagnation is prevented, and the injurious
matters which have accumulated in any place are diffused
throughout an immense medium, and so diluted that they
lose their noxious properties.

On the other hand, winds serve to transport malarious
emanations to a great distance, and are thus fruitful causes
of disease. This fact should not be lost sight of in select-
ing sites for barracks, hospitals, and encampments, which
should always, if possible, be placed so that the prevailing
winds will not pass over marsh, river, or other supposed
focus of malaria in the vicinity before reaching them.

Winds are more or less modified in their character ac-
cording to the direction from which they come. Through-
out the greater part of the United States an east wind
generally brings moisture with it, and is therefore liable
to induce catarrhs and rheumatic affections. In Texas a

PHYSICAL PROPERTIES OF THE ATMOSPHERE. 199

north wind, or a "norther," as it is called, causes a great
reduction in the temperature. On one occasion, in this
State, a party of soldiers and teamsters left one of the forts
in the morning to procure wood from a forest a few miles
distant. The day was warm, and they did not even take
their coats with them. Before night a norther came up,
and several of the party perished with cold before they
could reach the garrison.

In Kansas, and throughout the sandy region of country
known as the American Desert, during the summer season
the wind that comes from the south is extremely hot, arid,
and enervating. Diarrhoea and dysentery are prevalent
during its continuance, which is generally for two or three
weeks in midsummer.

In Italy, and along the northern shore of the Mediter-
ranean, a wind of a very debilitating and relaxing char-
acter, coming from the south-southeast, called the sirocco,
prevails periodically in early spring, lasting for from fifteen
to twenty days. During its continuance those who are at all
sensitive to its influence keep the house. Its effects upon
animal life are extremely depressing, and even plants
droop and wither under its action.

The simoom is still more noxious. It is a wind of the
deserts of Asia and Africa, not periodical, and lasting but
for a few minutes at a time. Animals of all kinds in-
stinctively fly for shelter at its approach, or crouch to the
earth till it has passed over. It is irrespirable, and if in-
haled only to a slight extent, produces asthma and exces-
sive debility, which last sometimes for several months.
This wind is not only hot and arid, but carries with it a
fine sand, which adds to its disagreeable effects. It is more
than probable that the simoom owes much of its deleterious
character to the presence of sulphurous acid.

There are other winds possessing special characteristics,
particular reference to which will be found in most works

200 A TREATISE ON HYGIENE.

on meteorology and those devoted to the consideration of
climate. In fact, the whole subject of aerial currents has
a most important bearing upon health, and is worthy of
more extended notice than can be given to it in a general
treatise.

CHAPTER IV.

TEMPERATURE.

Man is capable of enduring great extremes of heat and
cold. In the polar regions, where the mean temperature
for the year is as low as 3° Fahrenheit, and where the ther-
mometer for days together is frequently 50° below this
point, human beings are found enjoying life; subsisting
entirely on animal food, and dwelling in huts made of
the snow by which they are ever surrounded. Likewise
in the tropics, where the mean annual temperature is in
many places as high as 85° Fahrenheit, and where the mer-
cury in the shade often indicates a heat of 120°, races of
men live and flourish.

It is not to be denied, however, that the best specimens
of the human race are not found in climates where these
extreme ranges of temperature prevail. A mean annual
temperature of from 40° to 60° Fahrenheit is that under
which man physically and mentally attains the greatest
degree of vigor, and which is most conducive to health and
long life.

The ability of man to exist, with comparative comfort,
under extreme depression of temperature, is very much in-
fluenced by the degree of stillness in the air. Thus, in the

TEMPERATURE. 201

arctic regions a temperature of — 60° or — 70° Fahrenheit
can be borne if the air is at rest, whereas if a strong wind
is blowing a far higher degree of heat is unendurable. The
same rule holds good with regard to extremely high ranges
of temperature, warm air in motion being much more op-
pressive than air of the same temperature in a state of
repose. This fact was referred to when the subject of
winds was under consideration.

The ability to resist low temperature is very much in
accordance with the character of the food taken into the
stomach. The hydrocarbons, such as the fats and oils, are
most effectual in maintaining the heat of the body when it
is subjected to intense cold; alcoholic liquors have also the
same power, when taken in proper quantity. In very hot
climates the inhabitants live almost entirely on fruit and
carbohydrates, avoiding the use of fatty substances and
animal food.

The degree of dryness of the air is also a point to be
considered in connection with high and low temperatures,
each being more readily endured when the atmosphere is
dry. Thus, a heat of 350° has been tolerated for short
periods in a perfectly dry atmosphere, as in the case of the
workmen of Sir F. Chantrey, the sculptor, who were ac-
customed to enter furnaces heated to this point.* Arctic
voyagers have noticed their ability to resist extremely low
temperatures when the air was dry, which they could not
combat when it contained much moisture.

The effect of extreme depression of temperature is to
produce a torpor of the mental and physical faculties,
which, if yielded to, results in death before congelation of
the tissues has taken place. Captain Cook relates the par-
ticulars of an excursion of Sir Joseph Banks, Dr. Solander,
and nine others over the hills of Terra del Fuego, which

* Carpenter's Principles of Human Physiology. Am. ed., p. 620.

202 A TREATISE ON HYGIENE.

afford a very striking illustration of this effect of extreme
cold. Dr. Solander was very well acquainted with the
consequences which result to the animal body from ex-
treme depression of temperature, and cautioned his com-
panions against yielding to the intense desire to sleep, with
which they were liable to be affected, and urged them to
continue in motion. " Whoever sits down will sleep," said
he, "and whoever sleeps will wake no more." He him-
self was the first to experience this irresistible inclination
to rest and sleep, and, notwithstanding his knowledge of
the consequences that would ensue, he entreated his com-
panions to allow him to lie down. They knowing, from
the information he had given them, the fate to which he
would be subjected, urged him forward, but becoming ex-
hausted themselves they were finally obliged to leave him
behind with two black servants, who had also become
drowsy. Dr. Solander was, however, roused, though with
great difficulty, and carried to a fire which some of the
men had succeeded in kindling. Though he had slept but
five minutes, he very narrowly escaped death, and for a
considerable period afterward was deprived of the use of
his limbs. The two negro men perished.*

Many other instances similar to the above will be found
recorded by travellers and historians. Thus Charles XII.
lost two thousand men in the bleak and barren plains of
Ukraine. Napoleon, who entered Russia with an army of
five hundred thousand men, crossed the boundary on his
return with scarcely thirty thousand. The great majority
of the remainder had perished with cold.

It has several times occurred to me to notice this effect
of cold in producing numbness and drowsiness. On one
occasion I was myself nearly overcome by an intense de-
sire to sleep produced by a sudden change in temperature,

* Cyclopedia of Practical Medicine, article Cold, vol. i. p. 454.

TEMPERATURE. 203

by which the thermometer fell in about two hours from
52° to 22° Fahrenheit. I was crossing the mountain ridge
between Ceboletta and Covero, in New Mexico, and if I
had had much farther to go should probably have suc-
cumbed. As it was, I reached a rancho in time to be re-
lieved, though it was several minutes before I could speak.
The sensations experienced were far from being disagree-
able, and with all these was a feeling of recklessness of
consequences that made it a matter of indifference whether
life was preserved or not.

The influence of cold is very great in giving rise to dis-
ease. One of the chief causes of tetanus is cold conjoined
with moisture. Idiopathic tetanus is often produced by
exposure to cold winds or by lying down on the cold
ground. Traumatic tetanus likewise is frequently super-
induced, by the wounded in battle being obliged to lie
during the night on the field, exposed to the dews and
reduction of temperature which ensue. Certainly the very
great majority of cases of tetanus which have come under
my observation, during the present rebellion, have been
caused by exposure to these influences. A frog can at any
time be thrown into a tetanoid state by placing it in water
eight or ten degrees lower in temperature than the medium
in which it was, before trying the experiment.

By its action in depressing the vital power and con-
stringing the blood-vessels near the surface, cold gives rise
to internal congestions and inflammations. Apoplexy is
more frequent, for this reason, during winter than in sum-
mer. Bronchitis, pneumonia, diarrhoea, and rheumatism
are produced in this way.

Cold also produces an effect upon the organism when
one part of the body is reduced in temperature below the
rest. Thus cold hands or feet produce, probably through
the nervous system, inflammations of internal viscera, and
a draught of air striking on an exposed part of the body

204

A TREATISE ON HYGIENE.

will give rise to like results. When the body is over-
heated and commencing to cool, a drink of cold water may
produce instant death ; but if the heat of the body is still
at its height, no injurious consequences follow. After
severe exercise, from which the temperature of the body
has become elevated, we should not therefore stop to rest
before taking a drink of cold water or plunging into a
cold bath. If either is indulged in, it should be before the
cooling process has commenced.

The sickness and mortality of the United States forces
have, since the commencement of the rebellion, been much
less during the winter months of the year than during
those of summer. These facts, in regard to the sickness
rates, are shown in the accompanying table, prepared by
Assistant Surgeon J. J. Woodward, United States Army,
from the data in the Surgeon-General's office. It relates
but to five of the armies, and is based upon returns from
about three hundred thousand troops. The results are cer-
tainly different from those obtained in European countries.

Table showing the Monthly Ratios of all Diseases per 1000
of mean strength.

1861.

1862.

o
5

o •

M
§

a
a

<r>

211-
218-

292-
112.
183-

u
9

189-
216-
216-
159-
154-

JC5
O

160-
246-
195-
220-
150-

234-
231-

209-
256-
108-

261-
168-
263-
203-
68-

1-3

314-
210-

262-
259-
104-

Army of Poto-

479-
227-

540-
203-

428-
273-

448-
249-

312-
262-

392-
280-

280-
318-
271-
233-
222-

276-
267-
346-
158-
173-

248-
250-
353-
105-
151-

Army in Western
South Carolina
Troops in Flor-

Troops in Kan-

TEMPERATURE. 205

One of the principal effects of extreme cold is to cause
congelation of the tissues. The natural temperature of the
blood at the center of circulation is about 98° Fahrenheit,
and this cannot be reduced more than a very few degrees
without death being the result. Extreme cold may, how-
ever, act only upon those parts which are farthest from the
center of the body, as the hands and feet, the ears and
nose. In certain diseases attended with deficient power of
the circulation, as in typhoid fever and scurvy, congelation
is liable to occur from the effects of a temperature which
would not give rise to it in the healthy subject. I have wit-
nessed several instances of this fact, and many are recorded
as occurring in the Crimean war. Too much care cannot
be taken to maintain the heat of the body in such diseases
during the prevalence of low temperatures.

The consequences of extremely high temperatures are
no less well marked than those we have considered.
When continued for any great length of time, diseases of
the liver, diarrhoea, dysentery, and fevers are induced.
The effects of the direct rays of the sun in hot weather
are often of a very serious character. Troops should
always, as much as possible, be sheltered from their influ-
ence. Sun-stroke, by which congestion of the brain and a
peculiar effect upon this organ and the other parts of the
nervous system are produced, may be prevented by the
use of suitable covering for the head. The turban of the
zouaves is undoubtedly the best in this respect which has
been devised, the thick white folds of linen or muslin serv-
ing as a great protection from the sun's rays. A wet cloth,
folded and placed in the crown of the cap, is also an excel-
lent means of preventing the access to the head of the
excessive heat of the vertical sun.

Temperature has also great influence over the produc-
tion of malarious and certain other zymotic diseases. A
temperature of 32° Fahrenheit destroys the malarial poison

206 A TREATISE ON HYGIENE.

and that which gives rise to yellow fever, but does not
appear to control the contagious principle which causes the
exanthemata.

Those races which live in hot climates are always of
dark complexion, and dark hair and eyes. They are
generally more delicately organized than the races which
inhabit cold or temperate regions.

One of the greatest cares of the medical officer of a hos-
pital is the regulation of the temperature to which his
patients are to be subjected. The sick and feeble will not
bear the low temperature which, to those in good condition,
acts as a healthful stimulant. The various means of pro-
viding the proper amount of heat will be fully considered
hereafter, but it is proper now to insist upon the utmost
attention being given to the maintenance of a standard
temperature in the wards. Thermometers should be
placed, in large wards, at intervals of every thirty feet,
and the heat in winter should be maintained, as nearly as
possible, at from 62° to 66° of Fahrenheit. In summer the
matter is not so much under control, but, by judicious ven-
tilation, the air can always in hot days be kept several
degrees below the temperature of the external atmosphere.

CHAPTER V.

LIGHT.

For the full development of most animal and vegetable
forms light is essential. Though it is true that many
species of both kingdoms exist without ever being sub-
jected to the influence of a single ray of light, they are of
low orders, and scarcely constitute exceptions to the rule.

LIGHT.

207

Plants deprived of the influence of light become blanched
and stunted; animals are similarly affected. The tadpole,
which, under normal circumstances, develops into the frog,
when subjected to darkness, does not undergo the trans-
formation with the same degree of promptness, and may
even be thereby entirely prevented from becoming a perfect

reptile.

Edwards,* who instituted experiments relative to this
point, came to the conclusion that the action of light is to
develop the different parts of the body in that just propor-
tion which characterizes the type of the species, for he
found that growth was not prevented, the tadpoles de-
prived of light continuing to increase in size, but without
undergoing change of form.

I have several times repeated his experiments, and
always with analogous results. On one occasion I pre-
vented, for one hundred and twenty-five days, the develop-
ment of a tadpole, by confining it in a vessel to which the
rays of light had no access. On placing it in a receptacle
open to the light, the transformation was at once com-
menced, and was effected in fifteen days.

The influence of light upon other animals is also well
marked. It is almost invariably the case that those parts
of the bodies of animals nearest the ground, and, conse-
quently, least under the influence of light, are white or
colorless The brilliant colors which belong to the plants
and animals of almost every kind found in the tropic*, are
doubtless due, in part at least, to the influence of light.

In plants light decomposes carbonic acid and is the
principal agent in the formation of chlorophyll. In man it
Is through its influence that the pigment™ nigrum of the
skin is produced. That it is not formed through the action
of heat, is, as Levy observes, proven by thejact^the

* The Influence of Physical Agents on Life, p. 121

208 A TREATISE ON HYGIENE.

Greenlanders, the Esquimaux, and other arctic inhabitants
are of dark skin and hair.

The importance of light in a hygienic point of view can
scarcely be overestimated. Individuals deprived of it from
an early age, as are the denizens of courts and cellars, are
generally of low vital power. The offspring of such are
frequently deformed, and are always weak and puny.
From the observations of those who have given attention
to this subject, there appears to be no doubt that scrofula
is often produced in children by the deprivation of the
solar rays.

In miners and their families the effects of insufficient
light are more fully exhibited than in any other class of
people. Living sometimes almost entirely in obscurity
only slightly dispelled by artificial illumination, they are
thin, extremely subject to deformities, and completely
etiolated.

Etiolation is well described by Riembault.* According
to this author, it is characterized by a diminution of the
fibrin, the albumen, and the red globules of the blood,
while the water is augmented in quantity. The face is
discolored, and acquires a tint analogous to that of yellow
wax; the veins of the skin are no longer to be perceived,
even in those parts where they are largest and most
numerous ; the pulse is very frequent, beating at the rate
of from 90 to 100 per minute without increasing the heat
of the skin; there are palpitations and a bellows murmur
in the heart and carotids. The prostration of the forces of
life is extreme, and it is distressing to see the miserable
beings thus affected scarcely capable of sustaining their
lean and prematurely decrepit bodies. They are ex-
tremely subject to dropsy, to petechia, and to passive
hemorrhages.

* Hygiene des Ouvriers Mineurs, etc. Paris, 1861, p. H9.

LIGHT. 209

These effects are, many of them, seen, though less
strongly manifested, in the inmates of wards and sick
chambers from which the light is carefully excluded. I
shall never forget the appearance presented by the sick of
a regiment I inspected, about a year since, in Western
Virginia. They were crowded into a small room, from
which the light was shut out by blinds of India-rubber
cloth. Tale, exsanguined, ghost-like looking forms, they
seemed to be scarcely mortal. Convalescence was almost
impossible; and doubtless many of them died who, had
they been subjected to the operation of the simplest laws
of nature, would have recovered.

On the other hand, it is to be recollected that an exces-
sive amount of light is not only injurious in certain dis-
eases, but is also capable of inducing disordered action in
persons who are in a good state of health. Soldiers ex-
posed to the reflection of the sun's rays from the sand or
from snow, suffer to a great extent from eye diseases. I
have seen a number of cases of temporary blindness pro-
duced from both these causes, and many are on record to
the same effect, noticed by other observers. Thus Levy*
mentions that in 1819 the Swiss soldiers in garrison at
Lyons had many of their number affected with hemera-
lopia, accompanied with nervous symptoms, such as nau-
sea, vomiting, etc., due to drilling under a hot sun. The
Greeks, as related by Xenophon, suffered severely by the
reflection of the light from the snow as they crossed the
mountains of Armenia, many of them losing their sight.
Voyagers to the polar regions all mention the snow-blind-
ness by which not only their own men were affected, but

the natives also.

Purulent conjunctivitis and other inflammatory affec-
tions of the eyes are caused by excessive light, but the

* Op. cit., p. 352.

210 A TREATISE ON HYGIENE.

most common morbid result of exposure to intense light is
amaurosis, which may be either temporary, as is generally
the case, or permanent, resulting from congestion or inflam-
mation of the nervous apparatus of the eye. Such effects
may be caused either by the direct or reflected rays of the
sun, by a flash of electricity passing near the individual, or
by intense artificial light. I know a child who was ren-
dered permanently amaurotic by looking intently at a
bright object while she was having her photograph taken.

In the management of diseases, light can be often em-
ployed with advantage, and often must be, to a great
extent, shut off from access to the patient.

In chlorosis, scrofula, phthisis, and, in general, all dis-
eases characterized by deficiency of vital power, light
should not be debarred. In convalescence from almost all
diseases it acts, unless too intense or too long continued, as
a most healthful stimulant, both to the nervous and physi-
cal systems. The evil effects of keeping such patients in
obscurity are frequently very decidedly shown, and cannot
be too carefully guarded against by the physician. The
delirium and weakness, which are by no means seldom met
with in convalescents kept in darkness, disappear like
magic when the rays of the sun are allowed to enter the
chamber. I think I have noticed that wounds heal with
greater rapidity when the light is allowed to reach them
than when they are kept continually covered. Ribes*
makes a similar statement.

In active delirium, in inflammation of the brain, and in
all diseases attended with great nervous excitement, light
should be excluded from the patient. Small-pox also
seems to progress more favorably in darkness, and cer-
tainly exposure of the pustules to the light appears to be
the cause of the permanent scars which remain after
convalescence.

* Traite d'Hygiene Therapeutique, etc. Paris, 1860, p. 207.

ELECTRICITY. 211

CHAPTER VI.

ELECTRICITY.

The study of the therapeutical and physiological action
of electricity has been very much advanced by the labors
of Galvani, Volta, Matteucci, Louget, Bernard, Du Bois-
Reymond and many others, but its etiological influence is
by no means as well understood, and we are at this day,
to a great extent, ignorant of the part played by this
agent in the production of disease, or in the preservation
of health.

But we are not altogether without information on these
points. We know that electricity is the cause of the for-
mation of the ozone found in the atmosphere, and, as we
have seen, this principle exercises an important influence
over human health. We know, too, that rain and storms
are produced through its action, and that they are power-
ful hygienic and pathological factors. But these are not
primary instances of its influence, and beyond a few scat-
tered facts, which indicate that it is capable of affecting
the nervous system, that certain diseases have been occa-
sionally cured by it, and that death results from a powerful
shock, we know little or nothing relative to the connection
of atmospheric electricity with the sanitary condition of

man.

I have known weak and nervous women to be hysteri-
cally affected at the approach of a thunder-storm; but
whether this was due to fright or to any action of the
electricity on the nervous system, is difficult to decide.

It is probable that the rapid passage of electricity from

212 A TREATISE ON HYGIENE.

the body is productive of languor and malaise. We know
that on a clear, cold, and dry morning, when the air is a
bad conductor, the animal spirits are high, and that there
is a general feeling of energy and strength; but even here
it is by no means certain that the meteorological agents
associated with electricity are not the prime causes of the
well-being of the organism.

It is also stated* that at the approach of a thunder-storm
dyspnoea, due to emphysema and heart disease, gets worse;
patients suffering from chronic rheumatism and neuralgia
complain of increased pain; paroxysms of intermittent
fever anticipate the usual time of occurrence; the symp-
toms attendant upon certain acute diseases, as pneumonia,
grow more alarming, and that in fatal cases death will
arrive earlier in stormy weather than might else have
been anticipated. Some of these assumed consequences of
the approach of thunder-storms are extremely problemati-
cal, and all, even if resulting from such a cause, admit of
other explanation, with fully as much probability.

The experiments of Achard-|- appear to show that elec-
tricity promotes the decomposition of organic substances.
This observer electrified pieces of boiled beef and veal, and
found that they commenced to putrefy much sooner than
similar pieces placed under otherwise similar conditions.

Van Marum found that the amount of insensible perspi-
ration was very considerably lessened by electricity.

Through the action of the atmospheric electric shock
individuals who had been deprived of speech and sight
have had these faculties restored to them; and Dr. John
Le ConteJ mentions the case of a negro woman, seventy

* A Treatise on Medical Electricity, etc., by J. Althaus, M.D. Lon-
don, 1859, p. 341.

f Quoted by the editor of the English edition of Edwards on the
Influence of Physical Agents, etc., p. 195.

% New York Journal of Medicine, 1844.

WATER. 213

years of age, who had not menstruated for twenty years,
but who, after having been struck by lightning, had her
menses restored and rendered regular, for more than a year
afterward.

As has been said, the therapeutics of electricity have
been well studied, and the amount of our knowledge on
this point is extensive. Neither this, however, nor the
many beautiful and important observations which have
been made in regard to the purely physiological relations
of this agent, come within the scope of this treatise.

CHAPTER VII.

WATER.

Water in a state of vapor, as it exists in the atmos-
phere, has already engaged our attention, and we have
now to consider it as a substance necessary to life. Under
this head its relations are very numerous. The various
kinds of water; the means of examining as to its purity;
the several methods in use for freeing it of matters which
render it unfit for ingestion or for the other purposes of
every-day life; the diseases which are induced by impure
water, etc. are subjects of so much importance, in a sani-
tary point of view, that we shall not hesitate to enter into
their full consideration.

Water is a compound of hydrogen and oxygen, united
in the proportion of eight parts of the former to one of the
latter by weight, or one volume of oxygen to two volumes
of hydrogen by measure. Its formula is HO, and it is
therefore °a protoxide of hydrogen. It constitutes about

214 A TREATISE ON HYGIENE.

three-fourths of the surface of the earth, and the greater
part of the body of man and other animals. Some vege-
tables contain as much as ninety-five per cent, of water.
When pure, it is without taste or odor; its freezing point
is at 32° Fahrenheit, though it may, when kept perfectly
still, be cooled to a much lower temperature without
solidifying. At the level of the sea it boils at 212°
Fahrenheit.

Water is not always of the same character. It contains,
according to the source whence it is derived, certain sub-
stances dissolved in it, and frequently microscopic organ-
isms of various kinds. It is never found in nature in a
state of absolute purity. All water contains atmospheric
air in solution, which is driven off by ebullition, but which
is reabsorbed when the water is agitated with it.

Sea Water. — The water of the ocean is unfit for drinking
purposes on account of the large quantity of salt and other
mineral substances which it contains. Its taste is salt,
acrid, and bitter. Its exact composition varies with the
latitude and the depth at which it is collected. In the
polar regions it contains less mineral constituents than
elsewhere, owing to the great amount of ice which is con-
stantly being cast into it. The water of the Mediter-
ranean Sea, on the contrary, holds in solution a greater
quantity of mineral substances than that of any other
ocean, except the Atlantic Ocean at the equator. Accord-
ing to Marcet, the water of the middle of the Atlantic
Ocean contains, in 1000 parts by weight —

Chloride of sodium 26-600

Chloride of magnesium 5-154

Chloride of calcium 1-232

Sulphate of soda 4660

Total solid matter 37646

In addition, there are present bromide of sodium and mag-
nesium, and a small quantity of organic matter. Though

WATER. 215

there can scarcely be a doubt of the presence of iodine in
sea water, chemical analysis has so far failed to detect it.
Recent analyses would appear to determine the existence
of silver, lead, and copper, in very small quantity, in the
water of the ocean.

By distillation, and subsequent agitation with atmos-
pheric air, sea water is rendered fit for drinking; and most
vessels intended for carrying passengers are furnished with
apparatus for freeing salt water from its impurities.

The temperature of the water of the ocean is far more
equable than that of the superimposed atmosphere. Thus,
in the tropics, where the thermometer may indicate at
night 100° of Fahrenheit, and where in the direct rays of
the sun it stands much higher, the temperature of the sea
rarely rises above 80°. In temperate climates there is
scarcely any difference in the temperature of the ocean in
winter and summer, it being about 60° throughout the

year.

Rain Water.— The vapor which is being constantly given
off from the surface of the sea and rivers is condensed in
the atmosphere, and falls to the earth as rain. Rain water
is nearly pure; it contains, however, traces of organic mat-
ter, nitric acid, and ammonia, which it has derived from
the atmosphere in its passage through it. Snow and hail,
which are modified forms of rain water, possess similar
qualities when melted. Mr. J. T. May* has shown, how-
ever that snow contains a much larger quantity of am-
monia than rain; and M. Boussingault,t that the water of
city fo^s is especially rich in this substance, a fact which
sufficiently accounts for the irritating effects of such fogs
on the organs of respiration, even if we deny the agency of
ozone in producing this result. ^^

* On the Quantity of Ammonia and Nitric Acid in Rain Water.
Chemist, 1857, vol. iv. p. 362.

f Comptes Rendus, February 6th, 1854.

216 A TREATISE ON HYGIENE.

Rain water is sweet and soft, and, when filtered from
the impurities attracted from the atmosphere, colorless.
It is therefore entirely fit for the purposes of drinking and
washing.

Spring and well waters are impregnated with the solu-
ble materials present in the strata through which they
pass, and, accordingly, are often unfit for the ordinary pur-
poses of life. The temperature is variable, though gen-
erally they are colder than other waters. Hot springs are,
however, found in various parts of the world with tempera-
tures ranging as high as 212° Fahrenheit.

Mineral springs are those the water of which contains
notable proportions of mineral substances, such as iron,
sulphur, magnesia, etc.

Spring water is often exceedingly pure and soft, though
generally it contains lime and chlorides. These, however,
do not, unless in very large quantity, militate against the
use of spring water for drinking or washing.

JRiver water is similar in many respects to spring water.
It is often, however, contaminated with earth and sand,
and also with organic matters derived from decaying vege-
tation and animal remains, the sewerage of cities, the ref-
use of manufactories, etc. River water is that which is
generally supplied to cities, and also that which is usually
most at the command of armies.

After heavy rains, or the melting of ice and snow, pro-
ducing floods, river water is more apt to be loaded with
earthy matters than when a low stage of water prevails,
though, so far as the other impurities are concerned, these
causes produce an improvement in its quality.

Stagnant water is, from the amount of organic matter
which it holds in solution, not suited for drinking
purposes, although it is frequently sweet and limpid.
It should not therefore be so used as long as it is possible
to obtain running water.

WATER.

217

The water of marshes, ditches, canals, ponds, etc. all
come under this head.

Having thus briefly enumerated the various kinds of
water which are placed at the disposal of man, we come
to the consideration of them in their hygienic relations.
They are properly arranged into four groups: 1st, drink-
ing waters; 2d, mineral waters; 3d, bathing waters; and
4th, washing waters.

Drinking Waters. — The only waters which are fit for
drinking (excluding from this head the mineral waters,
which are properly medicinal) are rain water, river water,
and spring or well water.

A water to be suitable for this purpose should be free
from any considerable quantity of organic or mineral con-
stituents, and consequently colorless, and without any
peculiar odor or taste. At 30° Fahrenheit and 30 inches
of the barometer one hundred volumes of water contain
about five volumes of air. The large quantity of water
imbibed by an individual renders it a matter of great im-
portance that substances of a deleterious character should
not be present, or if they are, that they should be capable
of being readily removed.

The army surgeon is frequently called upon to decide
as to the fitness of water for the use of the troops, both
for drinking and washing, and he should therefore be
enabled to make a correct decision, and to suggest the
means that may be available for the purification of such
water as requires it. For these purposes very few appli-
ances, in the way of apparatus and tests, are required

All waters of the class under consideration, except rain
water, contain lime and chlorides, and frequently other
mineral substances, in solution. The lime is in combina-
tion with either carbonic or sulphuric acid, or both, and
the chlorides are those of sodium, magnesium, or potas-
sium It is probable that so far from being injurious, these

218 A TREATISE ON HYGIENE.

matters, when not present in too great a proportion, are
rather beneficial to the organism than otherwise. When,
however, they exist in large quantity, they produce intes-
tinal disturbance, and the lime salts undoubtedly give rise
to calculi in the kidneys or bladder. River water is also
often, as has been said, loaded with other impurities.
Some of these are of such a character as to cause serious
diseases in those who use the water in which they are
found, and are sometimes so abundant as to be destruc-
tive to the fish living in them. It is well known that the
white-bait, a very delicate fish inhabiting the Thames, is
not found above Greenwich, on account of the noxious
character of the water, due to the influx from the sewers
of London. The fish of the Schuylkill River, above the
falls, have been almost entirely destroyed by the water
pumped into it from the coal mines situated along its
banks or those of its tributaries.

The earthy matters which are so abundant in some of
our western river waters almost invariably cause diarrhoea
in those who are unaccustomed to their use, though this
effect gradually ceases to be produced if the drinking of
the water is persisted in. I have very frequently known
the water of the Mississippi, the Missouri, the Kansas, and
the Rio Grande give rise to severe diarrhoea, continuing
for several weeks, and occasionally terminating in ulcera-
tion and death. Even in persons who can at ordinary
times drink the water of these rivers with impunity, fre-
quent intestinal discharges are produced when floods have
caused an increased quantity of earthy matters to be held
in suspension.

In the selection of sites for camps, hospitals, barracks,
etc., the medical officer is often consulted with reference to
the character of the water. In the field it is frequently
impossible to camp the troops in positions which afford
good drinking water, but in the location of hospitals and

WATER.

219

permanent works this end can generally be insured. It
should be recollected that no one sanitary element is of
more importance than the one under consideration. I
have known stations selected without the least regard to
the character of the water; where this was so loaded
with saline matters that the men were almost constantly
affected with diarrhoea, or so contaminated with organic
substances that putrefaction commenced in a few hours
after it was brought to the quarters.

River and spring water almost always contains an ap-
. preciable quantity of sulphates. In the water supply of
towns, where the water is conveyed in part through leaden
pipes, this fact is one of very great importance, as on it
depends the property which such water possesses, of not
being rendered poisonous by its action on the lead. When
pure water, recently boiled, is placed in contact with lead,
no action takes place; but if the water has been exposed a
short time to the air, from which it absorbs oxygen and
carbonic acid, and is then placed in a leaden vessel, it is
not long before a white film, consisting of carbonate and
hydrated oxide of lead, forms on the surface of the metal.
This becomes detached, and falls to the bottom of the ves-
sel. It is highly poisonous. When, however, the water
contains sulphuric acid, this substance forms an adherent
coating of sulphate of lead, and prevents any further
chemical action. The purer the water, the more liable is
it to become contaminated with lead, when kept in cisterns
or transmitted through pipes of this metal. Ram water
not only contains oxygen and carbonic acid, but also nitric
acid which forms nitrate of lead, a salt soluble in the
water and not therefore to be detected by any but a
chemical examination. Rain water accordingly should
never be kept in cisterns lined with lead.

The quantity of lead necessary to produce poisonous effects

220 A TREATISE ON HYGIENE.

is very small. In the Claremont poisoning, Dr. Hofmann*
found but one grain of lead to the gallon of water, and
much less than this quantity would in time produce inju-
rious results to the health of those using water thus con-
taminated. The Claremont water contained five grains of
saline matter to the gallon of water ; but one-half of this
was chloride of sodium.

Christisonf refers to the fact that lead colic was almost
unknown in Amsterdam till the inhabitants began to sub-
stitute lead roofs for tiles, when a violent epidemic of the
disease occurred, and committed great ravages.

With reference to the action of water upon lead, I have
instituted some experiments which fully corroborate those
of other observers. Thus, I took some rain water collected
directly in a wooden vessel, and placed it in a bright leaden
jar. Upon testing a portion of it twenty minutes afterward
by passing a current of sulphuretted hydrogen through it,
a brown precipitate of sulphuret of lead was formed. One
pint, after the water had been in the vessel six hours, con-
tained one-seventh of a grain of lead — a proportion amply
sufficient to have produced the most serious results if the
water in which it existed had been used as a drink for a
few weeks.

Another portion of rain water in which, to each gallon,
five grains of sulphate of magnesia were dissolved, was next
placed in the vessel. Upon examining it half an hour
afterward, no precipitate was produced by sulphuretted hy-
drogen, but a white coating had already commenced to
form around the surface of the metal. It was retained in
contact with the lead for thirty days, without giving evi-
dence of the presence of lead.

To a third portion of rain water five grains of sulphate

* Taylor on Poisons. Am. ed., p. 452.
f Treatise on Poisons, p. 407.

WATER.

221

of magnesia and five of chloride of sodium were added. No
taste was communicated thereby to the water. It was then
placed in another leaden jar, and examined as before, but
no lead was detected.

To a further portion five grains of chloride of sodium and
ten and a half grains of phosphate of soda were added. No
lead was detected in the water even after forty days' con-
tact with the metal.

Many other observations were made, the general result
of which was, that the purer the water, the more liable it
was to become contaminated with lead. Harrison* alludes
to the fact that upon examining soft water which has stood
in a lead cistern, by holding it up to ^he light, small dust-
like particles will be found suspended in it, which he
supposes to be carbonate of lead. I have examined these
particles micro-chemically, and am satisfied, from their
reactions, that they do consist of carbonate of lead.

Organic matters are frequently present in water, and
give it qualities which render it deleterious. They may be
either gaseous or morphological, as portions of decomposing
vegetable or animal remains, infusoria, algae, fungi, etc.
Water in which such matters are found readily becomes
putrescent, and is most noxious to the health of those who
use it as a drink, producing diarrhoea and fever.

Water which is stagnant is especially loaded with such
impurities, and is therefore peculiarly unfit for drinking
purposes When examined microscopically, abundant evi-
dence of its unsuitableness will be found. We have already
alluded to the fact that the water of marshes, when drank,
gives rise to malarious fevers. This can only be through
the organic matters present in them.

Rivers from which towns are supplied with water are

* Some Observations on the Contamination of Water by the Poison

of Lead, etc. London, 1852, p. 30.

222 A TREATISE ON HYGIENE.

often contaminated by the influx of the noxious contents of
sewers. It is on this account that the water of the Thames
is so impure. During the prevalence of the cholera in
London, in 1854, the water supplied to the city was exam-
ined microscopically by Dr. A. H. Hassall,* who states
"that there is no water supplied to the metropolis that
does not contain dead and living organic matter, both ani-
mal and vegetable." It was found that some of the water
furnished was more free from such substances than others,
and that those districts supplied with the better quality of
water had fewer deaths from cholera than those to which
the more impure water was distributed.

Dr. Acklandf states that in 1832 the parish of St. Clem-
ents suffered greatly from cholera, and that at that time
the water supply was derived from a stream into which
sewers emptied; whereas, in 1849 and 1854, when the
water was obtained from another and purer stream, the
mortality from this disease was small. Another instance
which he mentions is still more to the point. The city jail
and the county jail stand close to each other. The former
had never had any cases of cholera, while the latter was
visited each time that the disease prevailed in Oxford.
The county jail was supplied with water pumped from a
filthy pond within ten feet of one of the drains. Upon
obtaining the % water from another source the cholera dis-
appeared.

The late Dr. SnowJ brought forward many facts tending
to show that cholera was only communicated by means of
drinking water. Without accepting so exclusive a hy-
pothesis, we must admit that there is every probability

* Sutherland's Report on Epidemic Cholera in the Metropolis in 1854,
presented to Parliament in 1855, p. 41.

f Memoir on the Cholera at Oxford in the year 1854. London, 1856,
p. 51.

X Mode of Communication of Cholera. 2d edition, London, 1855.

WATER. 223

that this is one of the chief means by which the disease in
question is disseminated.

For the purpose of drinking, then, it is of essential im-
portance that water should be free from any very large
amount of mineral substances or organic matters. It should
be inodorous, clear, and without any well-defined taste. It
is scarcely possible, even were it desirable, to obtain water
entirely free from inorganic and organic matters. As has
been said, in passing through the strata of the earth's sur-
face, or over the beds of rivers, water dissolves all soluble
substances with which it comes in contact. Vegetable and
animal organisms are constantly found in it. It may be
said with truth that water in which infusoria do not exist
is not the best fitted for ingestion ; for so universally do
they make this fluid their habitat, that their absence is
prima facie evidence that something is wrong with the
water in which they are not found. Decaying animal and
vegetable remains are always injurious, and water containing
them in appreciable quantity should be absolutely avoided.
In the use of water there are certain principles by
which we should be guided. It should not be drank,
especially when very cold, when the body has been over-
heated and has commenced to cool. Immediate death has
frequently ensued from the neglect of this rule. The
habitual use of ice-cold water, so prevalent among all
classes in this country, is calculated to injure the tone of
the stomach, and to produce diphtheria. It is also often
the cause of diarrhoea, but when temperately used, tends to
keep the bowels open. I know a gentleman who can at
anv time produce in himself griping pains and loose dis-
charges by drinking a tumbler of ice-water. Severe colicky
pains are often the consequence of its use.

I do not think the drinking of large quantities of water
at meals is at all calculated to lessen the digestive powers
by diluting the gastric juice. Very soon after being swal-

224 A TREATISE ON HYGIENE.

lowed, water is absorbed directly into the circulation, and
the gastric juice is constantly being secreted while there is
food in the stomach. For many years I have been in the
habit of drinking several tumblers of water at each meal,
without in the least interfering with digestion, and I am
acquainted with other persons who have followed a similar
practice without injurious results. Experiment, however,
places the matter beyond any reasonable doubt.

I fed a dog moderately, and then administered to it a
pint of water. Fifteen minutes afterward the animal was
killed by division of the medulla. On opening the stomach,
having previously tied it at its cardiac and pyloric open-
ings, nearly all the water was found to have been absorbed.
The food was as far advanced in the process of digestion as
it should have been for the period during which it had
been in the stomach. There was the ordinary quantity of
gastric juice present.

Water, even in large quantities, so far from being inju-
rious when taken during or immediately after a meal, is, on
the contrary, serviceable through its action in softening the
food, and thereby rendering it more susceptible to the solv-
ent influence of the gastric juice. Through its own solvent
powers it dissolves certain of the principles of the food,
which are more rapidly made available for the formation
of tissue, by reason of the fact that they are absorbed with
the water directly into the blood.

Water drank before going to bed is also salutary, in
washing out any remains of food which may still continue
in the stomach.

Cold water taken upon an empty stomach is far more
injurious than when drank after a full meal has been in-
gested. Violent cramps, and vomiting and purging have
been produced by ice-water, drank when the stomach was
empty. I have witnessed several cases of this kind among
soldiers. Moderately cold water is that, however, which is

WATER 225

most grateful to the stomach, and is most efficacious in
quenching thirst.

Tepid water is insipid and nauseous, though occasionally,
in cases of dyspepsia, more agreeable than very cold water.

Hot water, when drank, excites the circulation, and com-
municates a glow to the skin. A draught of it taken at
night by those who are subject to coldness of the extremi-
ties, produces very agreeable results. If taken habitually,
and in large quantities, it weakens the tone of the stomach
and intestines.

More water is drank in summer than in winter, in con-
sequence of the increased loss which the system sustains
through the skin during warm weather.

The sensation of thirst is exceedingly painful, and is
much less endurable than hunger. The extreme dryness
and clamminess of the fauces and oesophagus, the parched
and swollen tongue, the fever and delirium which are some
of the accompaniments of extreme thirst, make a more
painful collection of symptoms than that which is attendant
on hunger. Though the sensation of thirst is experienced
at the upper extremity of the alimentary canal, the want
exists in the system at large. This is proven by the fact
that thirst may be assuaged by bathing, sufficient water
entering the blood through the pores of the skin to accom-
plish this act. It may also be relieved by injecting water
into the stomach. The strongest evidence, however, that
thirst does not consist in dryness of the fauces is afforded
by the fact cited by Bernard, and which I have several
times verified, that if a fistulous opening exist in the
stomach of a dog, so situated that the water drank will
escape by it as fast as imbibed, no matter how much the
animal drinks, its thirst is not abolished.

From the hardships to which they are often subjected,
soldiers are very liable to suffer from thirst, and frequently
from disordered sensations simulating thirst, but which in

226 A TREATISE ON HYGIENE.

reality are not evidences of a want of water in the organ-
ism. This state of the fauces is induced by the pernicious
habit of drinking at every stream of water that is met
with, and filling the canteen for continual use along the
road. The consequence is, that the throat acquires the
habit of being kept constantly wet, and when the customary
liquid is withheld for a few hours, very great distress,
scarcely to be distinguished from the first symptoms 01
thirst, is produced. By refusing to yield to these disordered
sensations, the bad habit may be in a little time corrected ;
but the men should be instructed by their officers to avoid,
as much as possible, in the first instance, giving themselves
up to a habit which is productive of great distress, and
which, when gratified, is indulged without any permanent
relief of the disagreeable feeling about the mouth and fauces
being obtained.

Thirst, when real, cannot be relieved by anything as well
as by water. Acidulated drinks allay it, but not so effects
ually as simple water. Wine and other alcoholic liquors
are worse. Perhaps the best substitute is cold tea. It cer-
tainly affords more relief than even water for the dryness
of the fauces and clamminess of the mouth, above referred
to as simulating thirst. Any solid substance, as a bullet
or a coin, kept in the mouth gives relief to these sensa-
tions.

Snow increases the sensation of thirst, ice lessens it.
Why this difference should exist in these two analogous
substances is not very apparent, but the fact is beyond
question. In fever, the relief afforded to the system by
the ingestion of ice is well marked. The heat of the skin
is reduced, and the nervous system quieted.

Examination of Drinking Water. — By ascertaining the
specific gravity of the water to be tested, a rough idea of
the quantity of solids contained in it can be obtained.

WATER.

227

Kirwan* gives the following formula for this purpose,
which he states will generally indicate the proportion
within one or two per cent.

Deduct from the specific gravity of the water the num-
ber 1000, and multiply the difference by 1-4, the product
will represent the quantity of solid contents. It gives the
weight of the salts in their most desiccated state, and con-
sequently freed from their water of crystallization. The
weight of fixed air must be also included.

Thus, if the water under examination possess a specific *
gravity of 1015, the 1000 subtracted from this sum leaves
15, which, multiplied by 1-4, gives 21, the number of parts
of solid matter in 1000 parts of the water. A better plan
is to evaporate to dryness a certain amount of water, and
to weigh the solid residue.

Sulphuric acid is most readily detected by solution of
chloride of barium, by the action of which a heavy white
precipitate of sulphate of baryta is produced.

Chlorhydric acid is indicated by solution of nitrate of
silver, by which a flaky precipitate of chloride of silver,
soluble in liquor ammonia, is thrown down.

SuIpJwretted hydrogen, if present, forms, with solution of
acetate of lead, a brown precipitate of sulphuret of lead.
In water containing lead, sulphuretted hydrogen, when
passed through it, gives a like precipitate.

Lime gives, with oxalate of ammonia, a white precipitate

of oxalate of lime. .

Magnesia is indicated by liquor ammomee, which sepa-
rates it as a light flaky precipitate

Iron forms, with tincture of galls, a black precipitate of
tannate of iron ; with ferrocyanide of potassium, a dark-blue
precipitate of ferrocyanide of iron isjbrmed.

* a Tr Pa tise on the Comoosition and Medical Properties of the Min-
eral WaC of Buxton, etc. etc. By Sir Charles Scuda.ore, M.D.,
F.R.S. London, 1833, p. 1.

228 A TREATISE ON HYGIENE.

It is seen therefore that, with a very few reagents, an
examination can be made which will afford valuable in-
formation relative to the character of the water tested. An
approximate idea of the quantity of each constituent
present may be formed in this way, which will, in general,
be all that is needed. When accurate results are desired,
a balance must be employed.

It is not intended to enter at length into the questions
connected with the chemical analysis of water. All that is
desired is to point out a few practical tests which can be
applied at a few minutes' notice, and with no other appa-
ratus than a couple of test tubes.

Organic Constituents. — The organic constituents of water
when not in solution are readily detected by means of the
microscope. The living structures will be found to consist
of confervoid algae (confervacese, desmidiaceae, diatomaceae,
etc.) and infusoria. Nearly all water contains a certain
proportion of these organisms, and stagnant water abounds
with them. The higher forms of infusoria do not, however,
frequent water which contains a large amount of decom-
posing vegetable or animal substances.

When water is found by microscopical examination to be
overstocked with infusorial or algoid structures, it is not
that which is best fitted for drinking purposes ; but before
arriving at a definite opinion, certain precautions are neces-
sary. A great deal of exaggeration has been indulged in
by the writers of popular works on microscopy relative to
these organisms. In themselves they are of little conse-
quence. It has never been shown that any of the infusoria
are poisonous. They simply afford evidence that the water
in which they are found contains organic matter. When
they are in great abundance, it is a safe presumption that
there is also a large quantity of food for them likewise
present, and this food consists of vegetable or animal mat-
ter. If such water is kept for a few hours in a vessel ex-

WATER. 229

posed to the air, it will become putrescent. Such water
will not support the higher forms of infusoria.

When pure distilled water is exposed to the air for a day
or two, and then examined microscopically, it will be found
to contain algae and infusoria. Rain water is especially
selected by these structures. The presence of a green
scum, consisting of confervoid growths, is no indication that
the water is impure. Many of them are only found in clear
and pure water, which they tend to keep sweet by their
purifying action. The zygnemaceaa and the diatomacese are
objectionable, on account of the readiness with which they
undergo fetid decomposition when disturbed and injured.*

Some of the vegetable and animal organisms found in
water impart to it uniform characteristic colors. Thus, a
green hue is given to it by certain species of protococcus
polycystis, etc., and a red tinge by other forms of protococ-
cus astasia, etc. The red color frequently found in the
snow of the polar regions and of great altitudes, is due to
the presence of a confervoid growth — Protococcus nivalis.

In examining water microscopically, with the view of
ascertaining its fitness for drinking, a drop should be taken
up with the pipette, placed on a glass slide, and covered
with a piece of thin glass. It is then ready for inspection.
The examination of the sediment affords no reliable indica-
tions relative to the proportion of living organisms present
in the water from which it has been deposited.

The spores of fungi are also often found in water, and
can be detected by microscopical examination. It is rare
that any but marsh water contains them. As we have
already seen, it is probable their presence is a source of dis-
ease to those drinking the water in which they are found.

Decaying vegetable and animal remains often require no
other means than the unaided senses for their detection.

* See Micrographic Dictionary, article Water, p. 684.

230 A TREATISE ON HYGIENE.

When minutely divided, the microscope will at once de-
termine their character.

Organic matters, when in solution, can be most satisfac-
torily discovered by means of solution of permanganate of
potassa. This salt gives a bright-red color to the distilled
water in which it is dissolved, which hue is entirely re-
moved on subjecting it to the action of organic matter. We
have thus a valuable means of detecting impurities which
would otherwise escape observation. The method of pro-
ceeding is very simple. A drop of saturated solution of
permanganate of potassa, or of Condy's disinfectant fluid,
(which consists of a solution of alkaline permanganates,)
added to a half pint of distilled water, gives to it a beautiful
pink color, which will remain permanent for a long time ;
but if the same quantity be added to any ordinary drinking
water, the permanganate is decomposed by the organic
matter present, and the characteristic color is destroyed as
soon as found. If there be much organic matter present,
more of the solution will be required to produce any color
at all ; and, by the quantity used to cause the formation of
a permanent pink tinge, we draw our conclusions relative
to the purity of the water examined. The presence of
minute particles of organic matter is also readily indicated
by this reagent.

I prepared a standard solution of permanganate of po-
tassa, one drop of which gave a permanent pink color to
ten fluid ounces of distilled water. Into this mixture I
placed a single blade of grass, with the effect of instantly
destroying the color. In another experiment, two drops of
an infusion of hay were sufficient to decolorize the solution.
It required four drops of the standard solution to give a
fixed color to ten ounces of the water introduced into the
City of Washington, eighteen to produce the same result in
ten ounces of water collected from a marsh in the rear of
the city, and twenty-seven in the water of the canal which
flows through the town.

WATER. 231

Organic matters may also be detected by sulphuric acid,
which gives a dark-brown or black color to water contain-
ing any considerable amount of such substances. It should
be added drop by drop to the water under examination.

Mineral Waters. — The subject of mineral waters is so
extensive that it is impossible to consider it with anything
like completeness in a general treatise. This is the less to
be regretted for the reason that there are several excellent
works which treat of the virtues of particular springs and
of mineral waters in general.* Almost every variety of
mineral water is found within the limits of the United
States, and these, with others, are manufactured by Mr.
Hanbury Smith, of New York, with great success, leaving
scarcely anything to be desired in this particular.

The action of mineral waters on the organism of course
depends upon the character of the substances which enter
into their composition. Those containing iron are useful
in chlorosis and other affections in which chalybeates are
indicated. Those in which alkaline carbonates predomi-
nate are of service in gout, rheumatism, and gravel. Those
in which iodine or its combinations exist may be advan-
tageously drank by individuals of scrofulous diathesis, with
goitre, syphilis, etc.

It would be well if arrangements were made for giving
the advantages of mineral waters to the sick of the army,
as is done in France. In addition to the benefits to be
derived from the waters of many springs at our disposal,
there can be no doubt that the associations connected with
such places would also prove in the highest degree bene-
ficial in a large class of cases of invalids who are not in a
condition to join their regiments, and yet scarcely fit sub-
jects for discharge. ■

* The mo^Jo^ete^rk on the baths of the United States and
Canada is the treatise of Dr. John Bell, of Philadelphia. There are also
aeveral other works on particnlar springs by different authors.

232 A TREATISE ON HYGIENE.

In regard to the examination of mineral waters, it is
scarcely necessary that the subject should be considered
here. All the principal springs of this country and of
Europe have been so thoroughly studied, and their waters
analyzed, that it would be a work of supererogation to go
over the ground again.

Bathing Waters. — For purposes of cleanliness, the re-
quisites in water for bathing do not differ from those
necessary in a good drinking water. For special hygienic
objects very great differences in waters exist. The most
universally used water in these relations is that of the
ocean, and its efficacy is not to be doubted in a number of
diseases which affect mankind, and as a restorator of men-
tal and physical vigor after long-continued labor of body
and mind.

Physiologically the action of sea-bathing has, with the
exception of the excellent observations made by Beneke,*
been very little studied. This physiologist found one of
the most important results of sea-bathing to be an increase
in the metamorphosis of tissue, and, as a consequence, that
more food was required than under ordinary circumstances.

Undoubtedly, however, much of the beneficial effect of
sea-bathing is to be ascribed to the sea air, and to the other
associations, mental, physical, and social, which belong to
the various watering-places on the sea-shore.

M. Levyf has detailed the results produced upon the
men at Dieppe who assist in the bathing, and who are,
consequently, immersed in the sea, as high as the waist or
knees, for many hours each day, while the season lasts.
According to this observer, the effects of the immersion de-
pend upon the height to which the water reaches. If it
extends as high as the breast, it gives rise, at the com-

* Ueber die Wirkung des Nordsee-Bades, etc. Gottingen, 1855.
f Aunales d'Hygiene, 1861, tome xv. p. 241.

WATER. 233

mencement of the season, to dyspnoea and anxiety, which
sometimes become so excessive as to oblige the guide to
leave the water. As the season advances, these sensations
become less strongly marked, and finally disappear.

When the extremities only are immersed, an intense
sensation of cold is experienced. If the water is entered
fasting, the cold felt is more severe, and the reaction is less
decided, than if a slight repast is taken previously.

The excretion of urine is very much increased in these
men, and at night they perspire profusely.

Though sea-bathing is calculated to be of benefit in
many diseased or disordered conditions of the system, it
is certainly productive of very injurious results in others.
In phthisis, for instance, it is far from being beneficial, and
cases of rheumatism are generally rendered worse by its
action. In women, however, who require a tonic course of
treatment on account of leucorrhcea, menorrhagia, amenor-
rhea, prolapsus uteri, chlorosis, etc., and in children suf-
fering from cholera infantum, tabes mesenterica, strumous
swellings of the glands and joints, etc., sea-bathing and sea
air are almost always serviceable.

In the army it could not fail to be useful in the cases of
those who are recovering from chronic diarrhoea, typhoid
or typhus fever, or from the debility consequent on wounds.
Its good effects have been well marked at Point Lookout
General Hospital, which, though not situated on the sea-
shore, possesses the advantages of sea air and the salt-water
bathing of Chesapeake Bay.

Mineral baths are useful in many disorders. Those con-
taining sulphur and iodine are beneficial in syphilitic and
mercurial affections, and in rheumatism, gout, and scrofu-
lous diseases.

In regard to the hygiene of ordinary bathing, few sub-
jects of sanitary science are of greater importance. In the
first place, by removing the accumulated excretions from

234 A TREATISE ON HYGIENE.

the surface of the skin, bathing opens the pores, and allows
of the free transpiration of those matters which it is the
office of the skin to remove from the system. Obstruction
to the action of this emunctory causes very great disturb-
ance in the working of the several organs of the body, and
disease is, in consequence, produced. Baths are properly
divided into cold, warm, and hot. Each of these varieties
produces a distinct and characteristic effect upon the or-
ganism ; and in addition there is the vapor bath, the action
of which is analogous to, though not identical with, the hot
bath.

Cold Baths. — The temperature of the cold bath ranges
between 33° and 70° Fahrenheit, according to the season
of the year ; for a bath that would feel quite cold in sum-
mer at 70°, would be moderately so in winter. A low
temperature is better borne, and the reaction is stronger, if
bodily exercise has been taken previously.

A cold bath should not be taken either immediately
before or after a meal, for it is liable to cause disordered
digestion by the disturbance which it creates in the distri-
bution of blood to the stomach and intestines. The best
period for cold bathing is either in the morning, about an
hour before breakfast, or at night before going to bed. In
the first case, the system is invigorated for the day, the
body has endured as great a reduction of temperature as it
is probable it will encounter, and has reacted from it, and
hence the liability to take cold is lessened. This period is
best for those who have vigorous constitutions, and who
consequently can get up a healthy reaction without the
aid of extraneous appliances. The night is better for ,
those who are not gifted with the fullest physical powers.
Immediately on leaving the bath, the individual should go
to bed, when reaction will progress by the aid of the cover-
ing, and a sound and refreshing sleep will generally follow.

A very safe guide as to the hygienic effect of cold bath-

WATER. 235

ing is afforded by the subsequent phenomena. The imme-
diate effect of the cold bath is to depress the vital powers.
The heart beats with less force and frequency; the nervous
system receives a shock, varying in strength according to
the higher or lower temperature of the water; the blood is
driven to the internal structures of the body, and the sur-
face is chilled. But if the organism is possessed of a due
degree of power, on leaving the bath these conditions com-
mence to change. The heart recovers its activity; the
nervous system regains its tone; the blood begins to return
to the surface, and a general glow pervades the system.
This condition is called the "reaction." If, however, the
vital powers are weak, this change takes place but slowly,
and even after several hours the normal balance is not re-
stored. The surface of the body continues cold— the ex-
tremities especially so; the countenance is shrunken and
bluish*; the torpor of the nervous system remains, and
there is consequently an indisposition to exertion of any
kind, and the circulation preserves its feebleness and

languor.

When cold baths are followed by the reaction above de-
scribed, it is certain that their influence upon the system
is good, but when a condition such as that last represented
ensues, it may be asserted with equal positiveness that
they are injurious. They should therefore be at once dis-
continued, and the tepid bath substituted for them.

Old persons and infants do not bear cold baths well. In
early and old age the system requires all the heat it can
obtain. In organic diseases, and generally m those of a
chronic character, from the effects of which the system has
become much reduced, cold baths should not be employed.
Much injury is therefore done by the indiscriminate em-
ployment of cold baths at the water-cures, as they are

called

There are various ways of administering the cold bath.

236 A TREATISE ON IIYGIENE.

Certain parts of the body only may be immersed, or the
whole body may be covered, as in the plunge bath, or the
water allowed to fall upon it from a height, as in the
shower bath. Of all the various forms of cold bathing, this
last gives the greatest shock to the system. It should
never be employed except by those of the strongest consti-
tutions. The practice which prevails in penitentiaries, and
from which the army is not altogether free, of administering
shower baths indiscriminately, without regard to the con-
stitution or condition of the individual, to refractory pris-
oners and soldiers, cannot be too severely reprehended as
both cruel and dangerous.

Rubbing the body with coarse towels after bathing is
beneficial, as tending to produce the necessary degree of
reaction. Active physical exercise also aids in accomplish-
ing the same result, as will likewise warm and stimulant
drinks.

Affusion of the body is the mildest way of employing cold
water as a bath. There are few constitutions so delicate
that the use of this means will not prove advantageous. A
mild glow is produced after the very slight depression of
temperature which the body undergoes. For very debili-
tated persons the temperature should not be too low ; 60°
will be well borne in the great majority of cases. The best
period of the day for the habitual use of the shower bath is
immediately after rising in the morning.

Cold affusion is useful in the treatment of several dis-
eases, especially those belonging to the exanthemata. The
great heat of the skin is lessened, and the force and fre-
quency of the pulse reduced.

The cold douche differs from the shower bath in this, that
in the former the stream is conducted to the part in a com-
pact column, while in the latter it is broken into smaller
streams. The douche is a powerful means of reducing the
activity of the vital processes, and in mania and sthenic

WATER. 237

delirium, as they were formerly witnessed, was very gen-
erally employed. It is occasionally useful as a therapeutic
measure in sprains, rheumatism, and other local affections,
but has few if any hygienic advantages over less powerful
means at our command. Cold water admits of many other
applications in medicine and surgery than those to which,
merely as examples, we have referred.

Warm Baths. — The temperature of the warm bath
ranges from 85° to 95° Fahrenheit. As a cleansing agent,
warm is far more efficacious than cold water, on account of
its increased solvent properties, and the greater facility
with which it removes the oily particles which have accu-
mulated on the skin.

The warm bath is better adapted to individuals of weak
constitution, and to old or very young persons, than the
cold bath. Its stimulating effects are moderate, but at the
same time decided. The blood is attracted to the surface,
the vessels are dilated, the nervous system participates in
the excitement, and the action of the heart is accelerated.
These phenomena continue for a short time after leaving
the bath, but are apt to be followed by a corresponding de-
gree of depression, unless the effect is kept up by the
natural action of bodily exercise.

The best period of the day for taking a warm bath is
about an hour previous to dinner, so that the circulation
will have time to resume its ordinary course before this
meal is eaten. If used immediately before or after a full
meal, the blood is directed in a great measure from the ab-
dominal viscera, and the secretions necessary for digestion
are interfered with.

Warm water is applied locally to different parts of the

body as a derivative, but its effects are not so great in this

respect as those which follow the employment of hot water.

Hot Baths.— The temperature of a hot bath is from 95°

to 110° Fahrenheit, the latter point being about as high a

238 A TREATISE ON HYGIENE.

degree of heat applied through the medium of water as the
whole body ordinarily can endure; though to particular
parts of the body a considerably greater temperature can
be applied without suffering being produced. Habit here
comes again into operation, as, by gradually increasing the
temperature, a much higher range can be reached.

The effects of hot water at 110° are very decidedly stim-
ulating, and, in a hygienic view, its uses are very limited.
Therapeutically it is beneficial in rheumatism, gout, and
affections of the kidneys. It also admits of partial applica-
tion for the relief of hemorrhoids, amenorrhcea, convulsions,
paralysis, etc.

There are a number of natural warm and hot springs in
the United States, the waters of which being in several in-
stances possessed of medicinal virtues, are much frequented
by invalids, and might be advantageously made use of in
army practice in the treatment of cases of chronic rheu-
matism and constitutional syphilis.

The water best adapted for ordinary bathing, in which
only the cleansing effects, or those due to the influence of
cold, heat, and moisture are desired, is that which is free
from much mineral or organic matters. If the former be
present in large quantity, the soap is not readily dissolved,
and hence the influence of this alkali is lost ; if the latter,
the body is subjected to contamination, from which very
injurious consequences may ensue.

It is greatly to be regretted that so little attention is
paid in the army to the requirements of health in the mat-
ter of frequent and systematic bathing. In the general and
post hospitals this subject receives its proper consideration.
Bathing tubs are supplied, and the means afforded of ob-
taining sufficient hot and cold water. No patient whose
condition does not absolutely forbid it is received without
his being well bathed in warm water ; but in the barracks
the means are not provided, and, in consequence, the men

WATER.

239

are obliged to adopt such make-shifts as they can, or go
without any but the most incomplete ablutions. It is to be
hoped that greater attention will be paid to this matter by
those who have the immediate charge of the men, and that
in time bath-houses will be built at all permanent posts and
encampments. Attention to this point could not fail to
add not only to the comfort but the health and consequent
efficiency of the forces.

In the British service this matter has received the full
consideration of the authorities, and ablution rooms and
bathing accommodations are provided for all barracks.
Previous to the appointment of a special commission by the
British government to examine into the sanitary condition
of the barracks and hospitals of the United Kingdom, there
was hardly a barrack provided with bathing facilities.*
The commission recommended that immediate provision
should be made for remedying this defect.

An arrangement similar to that described by M. Dunalf
as existing in the barracks at Marseilles, might be advan-
tageously adapted to nearly all our barracks.

A building about thirteen feet square was built, and di-
vided by a partition into two parts. The first was used as
an undressing room; the other was supplied with water
conveyed through a pipe from the city main. The pipe
was about an inch and a half in diameter, and was termin-
ated by another tube pierced throughout its length (about
three feet) by small holes. The men entered this chamber
from the one in which they had undressed, and passed in
rotation under the shower, three or four at a time. Each
man was furnished with a small piece of soap, and three

* General Report of the Commission appointed for Improving the
Sanitary Condition of Barracks and Hospitals. Presented to both
Houses of Parliament by command of Her Majesty. London, 1861, p. 47.

t Notice sur les Affusions Froides. Recueil de Memoires, etc., tome
1., 1861, p. 380.

240 A TREATISE ON HYGIENE.

minutes sufficed for the ablutions of each party. Three
hundred and fifty soldiers, under charge of their corporals
and the sergeant of the week, were thus washed every day
from twelve to four o'clock, and without disorder of any
kind. The effect upon the health of the men was well
marked. Skin eruptions were prevented, and gastric dis-
turbances and diarrhoea were rendered less frequent. By
keeping the body clean, the air of the barrack rooms was
made less offensive, and thus a great source of disease
deprived of much of its power.

In camps and garrisons the men should be regularly
marched to the river during the summer season, under
charge of an officer, and required to bathe. I am satisfied
that if this were made a part of their duty, there would be
a very marked diminution of sickness, and a very decided
increase in the comfort of all concerned. So far from the
men disliking bathing, when the subject is brought to their
attention, and the conveniences provided, they like it, ac-
cording to my experience and that of other officers with
whom I have consulted. M. Dunal expressly states that
the men took great pleasure in their shower baths at Mar-
seilles.

Though the subject of bathing admits of much further
consideration in its hygienic relations, we have already ex-
tended its discussion as far as the limits of this volume will
permit.

Washing Water. — Water for the purposes of washing
should be of the character known as soft. Hard waters
owe their peculiar properties to the presence of calcareous
and magnesian salts, and are unfit for washing till these
substances have been neutralized. Soap will not cause a
froth in such waters ; if added to them in small quantity it
is not dissolved, but forms a flaky precipitate with the salts
above mentioned. If soap continues to be added to hard
water, it finally separates all the objectionable constituents

WATER. 241

from it, and the water is thus rendered capable of dissolv-
ing any soap which may subsequently be placed in it.

Through soap we therefore have a ready test of the
adaptability of water for cleansing purposes. MM. Boutron
and Felix Brudet* are the originators of this means, which
is both of easy application and affords very accurate results.
A solution of soap is made in alcohol, and its strength
determined by means of a test solution of chloride of cal-
cium. From the amount of soap destroyed by a given
quantity of the water examined, an exact idea of the value
of this water for washing is at once obtained.

For ordinary purposes, when absolute exactitude is not
required, it is sufficient to form a test solution of soap, of
any convenient strength, and to add it to the water under
examination as long as a precipitate is thrown down. The
mottled Castile soap is the best to use. By this simple
method very good comparative results are obtained. That
water which requires most of the solution to be added to it
before the precipitate ceases to be formed, is least adapted
for washing purposes.

Soap, as will readily be inferred, is also an excellent test
of the quality of water as a drink, and can be so easily
employed that its use in examinations of the kind should
never be omitted.

The Means of Purifying Water. — The methods in use
for rendering water, which is impure, fit for the uses of
man, may be considered under two heads : First, the physi-
cal separation of the injurious substances; and second,
their destruction or removal by chemical agents.

The separation of impurities from water by mechanical
means is accomplished either by filtration, decantation,
agitation with atmospheric air, or distillation.

* Comptes Rendus, March 26th, 1855. Also, Chemist, vol. ii. 1855,
p. 418.

242 A TREATISE ON HYGIENE.

Filtration affords a very ready means of removing those
matters from water which are insoluble in it. Water filled
with earthy substances, but otherwise of good quality, may
be rendered very fit for drinking by filtering it through
sand contained in a pyramidal box. The apex of the box
is sawed off and loosely closed with a little hay or straw.
It is then inverted over a barrel and filled with sand.
The water to be filtered is poured on the sand and it
passes through to the vessel beneath perfectly freed of its
earthy particles. Many substances held in solution in
water can be thus removed from it. Even the saline con-
stituents of sea water are separated by a filtration through
a stratum of sand thirty feet thick.

This property of sand to act as a filter is frequently
made use of in hospitals and other large establishments,
where great quantities of pure water are required. Several
years since M. H. Fonvielle,* by causing the water sup-
plied to the Hotel-Dieu to pass, under a pressure of forty-
one feet, through a filter of sand, succeeded in furnishing
that hospital with an abundance of pure water.

Many other methods of making use of sand, wholly or
in part, have been devised, and are of easy application in
camps. That of Dr. Lindf is very simple. A large cask
is procured, and the head knocked out of one end, another
of less transverse diameter, but longer, having both beads
removed, is placed within the first. The inner cask is to
be about half filled with clean sand, and the space between
the casks is to be one-third filled with sand. A cock is to
be placed in the side of the outer cask at a point about
fifteen inches above the level of the sand in the interval.
Upon pouring the impure water into the inner cask it

* Memoir sur l'Hygiene et la Statistique des Hopitaux de Paris, par
M. A. Bouchardat. Ann. d'Hygiene, 1837, tome xviii. p. 319.
■j" On the Health of Seamen.

WATER.

243

filters through the sand and flows out of the cock in the
side of the outer cask. Boxes will, of course, answer every
purpose if barrels cannot be procured. By the use of this
means any camp can always be supplied with water free
at least from particles of mineral or organic matter.

The apparatus described by the late Dr. Cutbush,* of
the United States Navy, offers some advantages over that
last mentioned. A water-tight trough is constructed, and
divided into four compartments. The first of these is half
filled with gravel, powdered charcoal, and clean sand, in
alternate layers, the second is left empty, the third is two-
thirds filled with the substances mentioned, and the fourth
left empty. The partitions between the first and second,
and third and fourth compartments, are pierced near the
bottom by a number of holes, half an inch in diameter,
that between the second and third by similar holes near

Fig. 12.

the top of the trough, and the end of the trough is fur-
nished with a cock inserted a few inches above the level of
the sand. At the other end a barrel is placed, also sup-
plied with a cock. The whole arrangement is shown in
Fig. 12.

* Observations on the Means of Preserving the Health of Soldiers
and Sailors, etc. Philadelphia, 1808, p. 115.

244 A TREATISE ON HYGIENE.

When water is to be filtered it is poured into the bar-
rel, it passes thence into the fourth compartment, thence
through the holes near the bottom into the third. Here it
rises through the gravel, charcoal, and sand, depositing the
greater part of its impurities, and flows through the holes
at the top of the partition into the second receptacle.
Thence it passes through the holes near the bottom and
enters the first compartment, when, passing through the
strata contained therein, it flows out through the cock in
the end of the trough. From experience, I can speak of
this apparatus as being a very excellent one, and as acting
with sufficient rapidity to supply all the culinary and
drinking wants of a regiment of men.

In the next place we come to the consideration of the
charcoal filters, which, on many accounts, are to be pre-
ferred to any other. Charcoal possesses the great advant-
age of not only mechanically removing those impurities
which are suspended in the water, but it also acts, espe-
cially animal charcoal, in rendering water which is putres-
cent, or otherwise impure from the solution in it of animal
or vegetable substances, perfectly fresh and sweet.

Several years since Gaultier de Claubry,* at the request
of a filtering company of Paris using Fonvielle's method,
reported on the subject of charcoal as a filter, and came to
the conclusion that the advantages derived from it were
not such as to compensate for the increased expense and
inconvenience.

Although admitting the disinfecting qualities of the
charcoal, he decided that water purified by it regained,
after a certain time, its first properties, through the de-
composition of the organic matters still held in solution;
and that although animal charcoal was far preferable

* Rapport sur l'Emploi du Carbon pour le Filtrage en grand, des
Eaux Destinees aux Usages domestiques. Ann. d'Hygiene, 1841, tome
xxvi. p. 381.

WATER. 245

as a depurator to vegetable charcoal, the difference in
cost was not in relation with their disinfecting qualities.
He also determined that water, in passing through char-
coal, parted with a portion of the atmospheric air dis-
solved in it, amounting to as much as one twenty-sixth
part.

As to water, which has been thoroughly depurated by
charcoal, regaining its impurities after the lapse of any
length of time, provided proper means be taken to keep
organic matters from contact with it, my own experience
is altogether against the correctness of such a conclusion.
I have kept water, which had originally been of a very bad
quality — loaded with vegetable and mineral matters — for
over a year after purification by filtration through char-
coal, without its again becoming in the least impure.
Neither have I been able, after a number of experiments, to
ascertain that any of the air dissolved in water is absorbed
by the charcoal used in filtration, except a small portion
contained in the water first passed through the filter.

Common vegetable charcoal, either used with gravel and
sand, as in the apparatus mentioned by Dr. Cutbush, or
alone, can generally be employed in camps and garrisons
without inconvenience, and with the most satisfactory
results. Not only are the mineral and organic particles
removed, but a great portion of the impurities held in
solution are separated.

Various forms of carbon filters are manufactured, and
answer exceedingly well. One of the best that I have
seen is Fowler's, a large number of which were supplied
last summer to the army hospitals situated in places where
good water was not abundant. Fowler's carbon filter con-
sists of a hollow, porous sphere of finely powdered animal
charcoal, which has been made to retain its form by being
subjected to powerful pressure, contained in a cylindrical
tin box, in the bottom and circumference of which are

246

A TREATISE ON HYGIENE.

several small holes. A tube of India-rubber communicates
with the cavity in the sphere. (Fig. 13.)

Fig. 13.

To use this filter, it is placed in the water to be purified,
and exhaustion made with the mouth applied to the free
end of the tube. Care must be taken that the end of the
tube hangs lower than the position of the filter, otherwise
the water will not continue to flow. If this point is at-
tended to, on removing the mouth the water will issue
from the tube purified of any particles of matter it may
have contained. In this way water may be conveyed
from one barrel into another, and in the transit deprived
of its noxious ingredients. In Fig. 14 the mode of using
this filter is shown.

A very excellent and convenient filter is constructed of
a cylinder of porous bisque, communicating at one end
with a piece of India-rubber tubing. On putting the
cylinder in water and exhausting with the mouth at the
other end, a limpid stream is obtained, which will con-
tinue to run as a siphon if the proper conditions are com-
plied with. It is so small that it may readily be carried
in the pocket, weighing as it does scarcely an ounce and
a half.

247
far

WATER.

There are many other kinds of filters, but none, so fi
as I know, superior to those just described.

Fig. 14.

Decantation.— Water which contains heavy particles of
mineral substances may be, to a great extent, freed of
them by allowing it to remain in a vessel undisturbed for
several hours, so as to allow the impurities to subside. It
may then be drawn off by a siphon into another vessel, or
used without this operation. It will be found, however,
that although the water is rendered much clearer by allow-
ing it to stand for some time, it will not become perfectly
clear, owing to the fact that a great portion of the matter
is of about the same specific gravity as the water, and
consequently remains in suspension.

Agitation with atmospheric air is an excellent method of
freeing water of impurities which are dissolved in it. This

248 A TREATISE ON HYGIENE.

may be done either by pouring it from one barrel into
another through a colander, by blowing into it with a pair
of bellows, or by the use of the apparatus devised by Mr.
Osbridge, of the British Navy. This consists of a hand-
pump inserted into a cask of water, and by the action of
which the water is raised. It is then made to fall through
several sheets of tin, perforated like colanders. By this
means the water is divided into small particles, and freely
exposed to the action of the air. The decomposing mat-
ters are thus oxidized, and the water rendered sweet.
Water which has been kept at sea for a long time and has
become putrescent, may be made perfectly palatable by
this process.

Distillation. — By this method water may not only be
purified of palpable matters, but also of all impurities held
in solution. On a large scale it is conducted by means of
a copper still. For small operations retorts are used. All
sea-going vessels should be supplied with suitable appa-
ratus for distilling water. Even sailing vessels can be so
furnished with but little expense, a head and worm being
adapted to the boiler in which the soup is made. Sea
water is thus rendered sweet, and by agitation with atmos-
pheric air becomes perfectly fit for drinking purposes.
This last operation is very necessary, as water which has
been deprived of its air by boiling is very flat and insipid,
and does not fulfil all intended purposes in the economy.

As a distilling apparatus, however, nothing at present
in use is comparable to that devised by Dr. Normandy,
which not only purifies the water, but aerates it at the
same time. From a report made by Surgeon B. F. Bache,
United States Navy, for an examination of which I am in-
debted to Dr. Whelan, Chief of the Bureau of Medicine
and Surgery of the Navy, it appears that ten thousand
grains of the water furnished by this apparatus contains
but three grains of solid matter, equivalent to twenty-one

WATER. 249

grains to the imperial gallon, or -003 per cent. The water
from the hospital well at the navy yard, New York, which
is remarkably pure, contains *0184 per cent, of solid mat-
ter. Dr. Bache further states that " the product was clear,
not acid, and apparently thoroughly aerated and free from
the flat taste of ordinary distilled fresh water." It would
he well if the permanent sea-coast fortifications, which gen-
erally are not furnished with the best water, and all sea-
going vessels were supplied with this apparatus, which is
capable of yielding from three to five thousand gallons
daily of fresh aerated water.

Chemical Means of Purification. — By agents which
act chemically on water, impurities which it contains may
be neutralized or altogether destroyed. One of the most
simple means under this head is boiling, which precipitates
some of the mineral constituents that may be present, and
destroys all infusoria, spores of fungi, and, to some extent,
decomposing vegetable matter. Like water which has
been distilled, that which has been boiled requires to be
agitated with atmospheric air to be rendered palatable.

Organic matters may also be destroyed by adding quick-
lime to water containing them, but as there are other pro-
cesses possessing greater advantages, this is not recommended.
Alum, added to water in small quantities, causes mineral
particles to settle rapidly to the bottom.

The permanganate of potassa, or the solution of perman-
ganates prepared by Mr. Condy, of London, answers ad-
mirably well for the purification of water contaminated with
organic matter. Thus water, which has been taken from a
well situated in proximity to a cess-pool, privy, or other
source of impurities, may be deprived of its injurious quali-
ties by the addition to it of a very small proportion of solu-
tion of permanganate of potassa or of the fluid mentioned.
Half a teaspoonful of a saturated solution will, ordinarily,
answer for a gallon of impure water.

250 A TREATISE ON HYGIENE.

Water which is rendered hard by containing carbonate
of lime in solution, may be rendered soft and fit for washing
purposes by the process of Dr. Clark * This consists in
adding milk of lime to the water, whereby a carbonate of
lime is formed with the carbonic acid, which is precipitated
along with that held in solution by the excess of carbonic
acid.

From what has been said relative to the purification of
water, it will be seen that, for the ordinary uses of men in
camp or garrison, filtration is more generally applicable and
more advantageous than any other means, and that when
they can be procured, the carbon filters are to be preferred.
When more care is taken to insure a supply of pure water
to the troops, it will be found that a great reduction in the
rates of sickness and mortality will result.

CHAPTER VIII.

SOIL.

The crust of the earth, so far from being homogeneous,
varies very much in its composition according to the causes
which have been instrumental in giving it origin. These
causes are three — fire, water, and organic decomposition.
From the action of the first-named cause, we have basalt,
granite, lava, sand, etc.; from the second, limestone, sand-
stone, alluvial deposits, coral reefs formed by zoophytes
of their own skeletons and other matters derived from the
sea, etc. It is probable, however, that originally all soils

* Chemist, vol. Hi., 1856, p. 125.

soil. 251

were deposited from water, and that the agency of fire in
altering their characteristics was of subsequent action.

The third cause, organic decomposition, is of very great
importance in its influence over the hygienic condition of
man. Through its action in some places a vast amount of
matter is deposited, to form a portion of the crust of the
earth, and to contribute to the fertilization of the soil. To
this cause coal, (vegetable matter decomposed through the
agency of fire,) guano, (the excreta of birds,) and humus,
(vegetable matter decomposed under the influence of air,
heat, and moisture,) owe their origin.

In a work on hygiene, it is of course out of the question
to enter at any length into the consideration of the struc-
ture of the earth's surface, or of the various modifying in-
fluences which have been brought into action. All these
subjects are fully discussed in the several treatises on
geology, to which the student is referred for that knowledge
in regard to them of which he ought to possess himself.

The various kinds of soils differ in their capacity for heat.
Thus M. Schiibler,* from his observations, constructed the
following table, which shows great variations in this
respect : —

Faculty of retaining heat, that
Kind of Earth. of sand being 100.

Calcareous sand 100

Silicious sand 956

Gypsum ^3*2

Light clay ^69

Heavy clay fl'l

Argillaceous earth 68'4

Pure clay 66*T

Calcareous matter in fine powder 61-8

Humus 49- °

As Levy remarks, we see from these results the cause of
the great heat retained by sandy soils in summer, after the

* Traite de Hygiene, par M. Levy, tome i. p. 480.

252

A TREATISE ON HYGIENE.

sun has set. I have frequently noticed the difference be-
tween a soil composed of humus and one consisting almost
entirely of sand, when I have had occasion to sleep all
night on the ground. On the elevated table-lands of New
Mexico the nights were always cool, and it was therefore
a matter of importance, in bivouacking, to select a sandy
bed if possible. It is somewhat remarkable that a late
writer on hygiene* asserts that sand has " little capacity
for caloric."

The power of soils to absorb moisture constitutes one
important point in their hygienic relations, some being
much more retentive of it than others, and on this account
exerting a deleterious influence on human health. Two
circumstances conjoin to influence this hygroscopic prop-
erty — the porosity of the soil, and the proportion of deli-
quescent salts which enter into its composition.

M. Schiiblerf has also investigated this subject with ac-
curacy. He found that five hundred centigrammes of earth,
of the kinds specified in the accompanying table, spread out
over a surface of thirty-six thousand square millimetres,
had absorbed as follows : —

Kind of Earth.

Silicious sand

Calcareous sand

Gypsum

Light clay

Heavy clay

Argillaceous earth ...

Pure clay

Calcareous matter in fine powder
Humus

Cenligr.

0-0

10 5

12-5

15-0

18-5

130

40-0

Centigr.

0-0

1-5

0-5

130

15-0

18-0

210

15-5

48-5

In 48 hours.

Centigr.

0-0

1-5

0-5

14-0

170

200

240

17-5

55-0

Centigr.

0-0

1-5

0-5

140

17-5

20-5

245

17-5

60-0

It is thus perceived that the argillaceous soils and those
composed of humus are pre-eminently distinguished for their

* Hygiene, etc., by J. H. Pickford, M.D.
f Op. cit, p. 479.

London, 1858, p. 250.

soil. 253

ability to absorb moisture. On this account ground which
is in great part composed of these substances does not
answer well for camping purposes. Perhaps the worst of
all kinds of soil for a camp is that in which sand and
humus form the upper stratum, the lower or sub-soil being
formed of clay. Eain which falls on such ground, instead
of rapidly evaporating, soaks into and through the first
stratum, and, passing into the clayey sub-soil, is absorbed,
and causes the surface to remain for a long time damp and
unhealthy. On the contrary, when the soil is sandy, and
the sub-soil composed in great part of gravel, even when
the inclination of the surface is but slight, the water which
falls passes far into the earth, and exercises no injurious
effect. Many camps have been rendered unhealthy solely,
so far as could be perceived, through the bad character of
the soil in respect to its power of absorbing and retaining
moisture.

Soil which is covered with large trees or thick under-
growth is not so healthy as that which is exposed to the
air, and light and heat of the sun. Evaporation is retarded
under such circumstances, and the decomposition of the
organic matters present, instead of being speedily effected,
is rendered slow and persistent. Such places should never
be selected as sites for camps or barracks.

Some soils retain organic matters to a greater extent
than others, and hence are bad situations for the location of
camps. From some experiments I have recently performed,
I have been enabled to arrive at tolerably definite conclu-
sions on this subject.

Thus, in order to ascertain the character of the soil with
respect to organic exhalations, a weighed quantity (two
hundred and fifty grains) was subjected to the action of
a current of air in the apparatus represented in Fig. 15.
The potash-bulbs contained a measured quantity (six fluid

254

A TKEATISE ON" HYGIENE.

drachms) of a solution of permanganate of potassa of
definite strength, and the wide tube the soil to be exam-
ined. The aspirator was then set in action, and it was
observed how many cubic inches of air passing through the
soil were required to decolorize the solution of permanga-
nate. The potash-bulbs were then removed, and the large
tube immediately attached to the aspirator by one ex-
tremity, the other being placed in communication with a
large jar containing putrid meat, urine, and vegetables.

Fig. 15.

After a measured quantity of air (fifty cubic inches) had
passed through, the tube was separated from its connec-
tions, and the potash-bulbs, containing a fresh solution of
the permanganate of the same strength as that previously
used, were reattached. It was then observed how many
cubic inches of the air now passing through the soil were
required to decolorize the solution, and thus some indica-
tion was afforded of the amount of effluvia absorbed. The
following table exhibits the results obtained. The column
marked A shows the number of cubic inches of air required
to decolorize the permanganate solution before the soil was
exposed to the exhalations from the putrefying substances;
that marked B, the quantity of air required after the
exposure.

SOIL.

255

Kind of Soil.

Pure sand

Dry clay

Sand, clay, and marl
Humus

135
59
645
41

67 5
495
53
11-5

From this table, it would appear that all the substances
experimented with, absorbed to some extent the exhala-
tions from the decomposing substances, and that the humus
exceeded all the others in this respect, as, before submitting
it to the action of the noxious exhalation, it required forty-
one cubic inches of air passing through it to decolorize the
solution of permanganate of potassa, while eleven and a half
cubic inches sufficed after the exposure. It may be said
that the table only shows the relative facility with which
the several matters parted with the emanations. It cer-
tainly does show this; and, even if this were all, the result,
practically, would be of importance ; but upon comparing
the figures in the two columns obtained with each kind of
soil, I think it will be apparent that it also indicates the
absorptive power of each substance.

The configuration of the soil is also important in its sani-
tary bearings. Ground which is flat or concave is not well
adapted as a location for tents or buildings, on account of
the difficulty of draining it properly. On such a surface
water accumulates, and is only removed by evaporation or
absorption. A moderately rolling surface, or one that is
regularly inclined, best fulfils the requirements as to

drainage.

The vegetation of the soil is not without its influence over
the health of those living upon it. Thus, as we have said,
forests and other places having a thick vegetable growth
upon them are damp and often malarious. Moreover, when
the vegetation is luxuriant, decomposition is also active ;

256 A TREATISE ON HYGIENE.

so that the air and soil are loaded with the products of

decay.

Cultivation is an important element in the condition of
the soil as to health. Although the turning up of the
ground is in some parts of the country productive of mala-
rious disease, it invariably happens that as cultivation is
carried forward, the region becomes more and more healthy.
Through this means sections which were at one time noted
for their unhealthiness, have been entirely freed from the
diseases (generally those of malarious origin) to which they
had been liable. I have witnessed many examples of the
truth of this, especially in the West, where the correctness
of the view expressed is well understood.

CHAPTER IX.

LOCALITY.

That some places are more healthy than others, is well
known, but the circumstances which conduce to the differ-
ences observed in this respect are not always understood.
Undoubtedly the character of the atmosphere, of the water,
and of the soil are the chief factors in operation ; but there
are others of which we are ignorant, except through their
effects. It is more than probable, however, that if diligent
search were made in such cases, the causes of the un-
healthiness of certain localities would be found to belong
to one or other of the influences above mentioned. Thus,
we know that the valleys of mountainous regions are
favorable to the production of goitre and cretinism; but
why they are so, we do not know. We may suppose the

LOCALITY. 257

cause to be the character of the water used, or the want of
a due supply of light, or any other of the several influences
which have been brought forward; but we have no proof
that such is the case.

Mountains, plains, islands, cities, etc. all have their pecu-
liar hygienic features, and are subject to their own special
diseases, either through the action of nature or of man.
Though we cannot enter at length into the consideration
of all the bearings which locality exerts upon hygiene,
there are some points of more importance than others, to
which attention will be drawn.

Mountains. — The atmosphere of mountainous regions is
clear, cold, generally dry, and free, to a great extent, from
those impurities which are found in the air of low places.
The water is ordinarily free from any organic matters,
though occasionally it is highly impregnated with lime
and other mineral substances, according to the strata
through which it passes to the surface. The soil is usually
barren on account of the small amount of organic matter
present in it.

So far, therefore, as the atmosphere, water, and soil of
mountains are concerned, they would appear to be espe-
cially favorable in a sanitary point of view, but in some
other respects they are much less healthy than other
localities.

Thus in regard to light, the inhabitants of mountain
gorges and valleys are very disadvantageously situated.
We have seen how important a full supply of light is to
man and other organized beings, and we can understand
therefore why it so frequently happens that the inhabit-
ants of particular parts of mountain ranges and peaks are
stunted and etiolated. In regard to temperature, it is often
the case that mountains are subjected to a degree of cold
which is unfavorable to the full development and health of
the inhabitants.

258 A TREATISE ON HYGIENE.

Goitre and cretinism, to which allusion has been made,
are especially diseases of the mountains or of the valleys
inclosed by them. By some writers they have been as-
cribed to the influence of snow-water used as a drink ; but
this cannot be the cause, for these affections are never seen
in the arctic regions, where snow-water is the only bever-
age used by the inhabitants, and goitre is quite common in*
mountainous regions within the tropics, where there is an
entire absence of snow. Again, the presence of lime and
magnesia in the water drank has been supposed to give
rise to goitre and cretinism; the absence of iodine from the
water, the deficiency of light, the character of the food, and
many other agents have been brought forward, but unsus-
tained by any positive proof, so that we are really ignorant
of the cause of these diseases, which tend powerfully to the
physical and mental degeneration of those who are so un-
fortunate as to be affected by them. In this country
goitre is not very common, and cretinism is altogether
unknown. Both are more general in the mountainous
regions of Switzerland than anywhere else.

The disease met with among the hunters of the Rocky
Mountains, and called by them mountain fever, is scarcely
distinguishable from the ordinary typhoid fever of the
country. I have twice had opportunities of making post-
mortem examinations of individuals who had died of this
affection, and in both cases found the usual diseased
condition of Peyer's glands.

The air of the mountains, together with the change of
scenery and other associations, is especially beneficial in
those debilitated states of the system resulting from diar-
rhoea, dysentery, typhoid fever, or intense mental occupa-
tion. In chlorosis, and in diseased conditions of the men-
strual function, it is not indicated, the sea-shore being
preferable.

Very great altitudes are favorable residences for those

LOCALITY. 259

who are predisposed to phthisis, for the reason that they
conduce to a full development of the chest and respiratory
apparatus. Owing to the rarity of the atmosphere at such
heights, greater efforts are necessary to obtain the due
amount of oxygen. The respirations are deeper, and, as a
consequence, the chest becomes more expanded, and the
lungs more fully developed. For some time after a resi-
dence in places of great altitude, persons are subject to
dyspnoea upon the slightest physical exertion, but eventu-
ally this passes away, and the respiratory apparatus gains
in power and efficiency.

Mountainous localities are not favorable to the genera-
tion of malaria, though not entirely free from it. Diar-
rhoea, dysentery, and other affections of the bowels are
uncommon in such regions, but inflammations of the respi-
ratory organs are quite frequent.

Plains. — The sanitary condition of plains is very much
influenced by the position as to altitude, the vicinity of
mountain ranges, etc. The high table-lands which are
found in the neighborhood of the Rocky Mountains, and
in their continuation in South America, are noted for the
purity and salubrity of their atmosphere and their freedom
from endemic causes of disease. On the other hand, plains
which are low and surrounded with high lands are pro-
verbially unhealthy. Such plains are frequently alluvial
in their origin, and covered with a dense and rank vege-
table growth, which adds to their insalubrious character.

Marshes. — After the remarks which have already been
made in regard to malaria when the atmosphere was under
consideration, there is not much to say relative to marshes.
But aside from the fact that ordinarily they are foci of
malaria, they are unhealthy on account of the great extent
to w r hich vegetable decomposition goes on in them, and
the consequent exhalation from them of substances which
exert an injurious influence over human health. On this

260 A TEEATISE ON HYGIENE.

account, if for no other, camps should not be pitched in
their vicinity.

It is a mistake, however, to suppose that all marshes
produce malaria. I have known several extensive morasses,
in the immediate vicinity of which there were no mala-
rious diseases among the inhabitants.

Localities at the mouths of rivers are, as a rule, more un-
healthy than those at their sources. This fact is owing to
the deposit of organic matter which undergoes decomposi-
tion, or affords a favorable nidus for the growth of fungi,
the spores of which may give rise to malarious diseases.
Rivers, in passing through extensive regions covered with
a luxuriant vegetable growth, as those bordering the Mis-
sissippi, the Missouri, the Amazon, the Orinoco, etc., obtain
an abundance of matter tending to affect the healthiness of
cities located on their banks, especially those at their
mouths. Through the sewers and manufactories of large
cities, and animal matter of various kinds, other substances
injurious to the health of those living on the banks of
rivers are derived.

The Seashore. — The sea-shore is regarded by many as a
favorable residence during the warm season, at least for
invalids affected with nearly all diseases. For phthisical
patients, and for those with rheumatism, it does not ordi-
narily prove advantageous. The influence of sea-bathing
is often beneficial in such cases; but the constant humidity
of the atmosphere, and the liability to sudden changes of
temperature from cold winds, neutralize the benefits derived
from it. As a resort for those who are convalescing from
typhoid fever, diarrhoea, dysentery, and malarious diseases,
the sea-shore is particularly to be selected.

Islands, when not of very great extent, are possessed of
an average annual temperature much higher than neighbor-
ing places of the same latitude. Thus London is warmer than
places of the same latitude on the continent of Europe, or

LOCALITY. 261

even than Paris, which is several degrees south of it. The
influence of the warm currents of water which circulate
around the island of Great Britain is undoubtedly the main
cause of the greater amount of heat ; but with all islands
surrounded by large bodies of water the same effect results.
The interiors of some islands are therefore excellent places
of resort for those who are of a phthisical diathesis, and for
whom an equable climate is necessary.

Cities. — The hygiene of cities is of itself a subject so ex-
tensive as to constitute a separate science, and we shall do
no more than allude to a few points in connection with it
which have a bearing on individual hygiene.

The temperature of large cities is, owing to the number
of fires in dwelling-houses and factories, and to the vast
extent of brick and stone walls which absorb heat, higher
than the temperature of the surrounding country. The air
is more impure, in consequence of the many sources of
contamination which exist — the exhalations from numbers
of inhabitants, the gases given off by factories of all kinds,
the emanations from sewers and cess-pools, the immense
amount of carbon from the fires of thousands of houses, all
add matters to the atmosphere which render it more or less
noxious in its character.

Owing to the obstructions to the free circulation of the
air which exist, ventilation is not thoroughly effected, and
the impurities are consequently retained, to exert their
deleterious influence.

The mortality of cities is always greater than that of the
country. Some of the diseases are almost peculiar to them.
Such, for instance, is cholera infantum, which is best
treated by sending the patient to the country. Malarious
diseases do not prevail in the thickly inhabited parts of
large cities, though by no means rare in the outskirts.

There are several other points connected with the hy-
giene of cities which will be considered under other heads.

262 A TREATISE ON HYGIENE.

The food and chinks which are peculiar to localities
modify to a great extent the physiological and hygienic
conditions of the inhabitants ; but the full consideration of
their influence is reserved for another division of this
treatise.

CHAPTER X.

CLIMATE.

More has been written upon the sanitary influence of
climate than upon any other subject connected with
hygiene. The advantages of certain localities for certain
diseases, the necessity for change of air for others, and the
precautions to be observed by the invalids who seek health
by a change of residence, have all been studied to an ex-
tent that has made us well acquainted with these subjects.

But it is not only in its influence over health that cli-
mate has been observed. Its physical relations have also
engaged attention. Meteorology has made giant strides
within the last few years, and not the least part of its
progress has been directed to the elucidation of the vast
questions connected with the influence of temperature,
winds, water, electricity, altitude, etc., in the production of
that condition which we call climate.

The word climate, (from xh/ia, a region,) if taken in its
restricted sense, refers to one of the zones into which the
earth from the equator to the poles was divided by the an-
cient geographers. But at present it is ordinarily used to
mean the condition which results from the action of certain
meteorological factors on the altitude, the soil, the position,
and other telluric circumstances belonging to a region of

CLIMATE. 263

country. This condition influences the character of the
vegetation, the animals, and the sanitary state of all indi-
viduals, either of the vegetable or animal kingdom of
nature, which live under it. We find that a plant which
flourishes in one kind of climate droops and withers when
transplanted to another of different qualities ; that animals
brought from a climate to which they have been accus-
tomed to one which is strange to them, sicken and die; and
that the health and development of man are very greatly
influenced by the character of the climate in which he is<
placed, especially if it be one to which he has not become
habituated by long residence, or varying essentially from
that under which his ancestors have lived.

We have already considered most of the agencies which
contribute to the formation of climate, and we have only
to point out how they are connected to each other in this
relation, and the effects which result, in a hygienic point of
view, from the various combinations of which they are sus-
ceptible.

As Humboldt* observes: "If the surface of the earth
consisted of one and the same homogeneous fluid mass, or
of strata of rock having the same color, density, smooth-
ness, and power of absorbing heat from the solar rays, and
of radiating it in a similar manner through the atmosphere,
the isothermal, isotheral, and isochimenal lines would all
be parallel to the equator. In this hypothetical condition
of the earth's surface, the power of absorbing and emitting
heat would everywhere be the same under the same lati-
tudes."

Such a condition does not exist, and hence we find places
of the same latitude differing from one another in tempera-
ture, degree of moisture, etc., and thus having different
climates.

* Cosmos, vol. i. p. 324. Bohn's edition.

264 A TREATISE ON HYGIENE.

Climate is due to the latitude, the altitude, the nature
of the soil, its vegetation and its state of cultivation, the
situation with reference to oceans, lakes, or rivers, or to
mountain ranges, and the character and direction of the
prevailing winds.

Undoubtedly the most powerful cause of differences in
climates is that of latitude, or distance from the equator.
Classifying climates upon this basis, and they may be
arranged into three divisions — the hot, the cold, and the
temperate. But this division does not embrace all locali-
ties of the same latitude ; for, from extreme height above
the level of the sea in warm climates, or from the vicinity
of currents of warm water (as the Gulf Stream) in cold
regions, localities in the first instance are subjected to a
climate where perpetual snow exists, and in the last are
favored with such a moderate temperature as assimilates
them to localities situated much nearer to the equator. We
shall endeavor, in a general way, to point out briefly these
disturbing influences as they affect some regions, which,
but for them, would have the climate peculiar to their
latitude.

Hot Climates. — The regions situated under the equator,
and as far as 30° north and south of it, are subjected to
the influence of a warm climate. At the equator the mean
annual temperature is about 80° Fahrenheit, for the spring
84°, for summer 86°, for autumn 82°, and for winter 75°.
In the sun the temperature is of course very much higher,
reaching in summer, in some places, to 130°.

But within the lines of latitude mentioned as bounding
the region where a hot climate prevails are found high
mountain ranges, both on the eastern and western conti-
nents, on which all possible varieties of climate are to
be found, from the hot which exists at the base, to the
cold, characterized by the presence of perpetual snow.
The vegetation, the animals, the diseases also change,

CLIMATE. 265

and are assimilated to those which pertain to higher lati-
tudes.

On the coast of Peru, throughout a great portion of the
year the thermometer is very much depressed, standing as
low as 59°. According to Humboldt,* this effect is not to
be attributed to the neighborhood of mountains covered
with snow, but to the mist which obscures the sun's disk,
and to a current of cold water coming from the antarctic
regions and sweeping along the coast. This is cited merely
to recall to mind the fact previously stated relative to the
influence of water in modifying the temperature of the
land.

The division of the tropical year into seasons is not so
well marked as it is in more northern or southern lati-
tudes. In fact, there is no winter, but instead there are
six months of rainy season, during which the air is loaded
with moisture, and the temperature reduced not more than
ten degrees below the mean point of the summer months,
which constitute the rest of the year.

There are differences to be observed relative to the effect
of a residence in various parts of the tropics. According
to the observations that have been made it would appear
that America, within the tropics, is more healthy to Euro-
peans than places of corresponding latitudes in either Asia
or Africa. Africa is pre-eminently insalubrious, as is
shown by the returns of sickness and mortality of the
British army. Thus Colonel Tulloch states that from
1822 to 1830, 1658 white troops were sent to the British
possessions in Africa, and that of this number 1298
died from diseases due to the climate, and the remainder,
387 were invalided home and otherwise accounted for.
Of this number but 33 were reported as fit for service.
Owing to this great mortality, it was determined to remove

* Ansichten der Natur.

266 A TREATISE ON HYGIENE.

the white troops and to substitute negro regiments, dvawn
from the West Indies, in their place. This was done,
and with the effect of reducing very materially the amount
of sickness and mortality.

The unhealthiness of the west coast of Africa is to be
ascribed not only to the elevated temperature, but to the
great amount of humidity, to the want of cultivation of
the soil, and to the consequent rank vegetation which,
decaying, spreads abroad its pestiferous exhalations.

Lind,* in referring to this region of country, says : " This
wide extended coast appears, in most places, to be a flat
country, covered with low suspended clouds. Upon a
nearer approach, they are generally heavy dews, which fall
in the night, and the land is every morning and evening
wrapped up in a fog. Upon examining the face of the
country, it is found clothed with a pleasant and perpetual
verdure, but altogether uncultivated, excepting a few spots,
which are generally surrounded with forests or thickets of
trees, impenetrable to refreshing breezes, and fit only for
the resort of wild beasts.

"The soil, like all other low lands, is either marshy or
watered with rivers or rivulets, whose swampy and oozy
banks are overrun with sedges, mangroves, and the most
noxious weeds, on which there is a quantity of slime and
filth that sends forth an intolerable stench, especially to-
ward the evening."

Subsequently Lind statesf that it scarcely admits of a
doubt that if any tract of land in Guinea was as well im-
proved as the Island of Barbadoes, and as perfectly freed
from trees, shrubs, marshes, etc., the air would be rendered
equally healthful there as in that pleasant West India
island.

* An Essay on the Diseases incidental to Europeans in Hot Climates
London, 1768, p. 44.
f Op. cit., p. 51.

CLIMATE. 267

Daniell* also expresses the opinion that the extreme un-
healthiness of Africa is due to the humidity of its atmos-
phere, conjoined with an elevated temperature and the
presence of exhalations caused by the decomposition of a
vast amount of vegetable matter.

In Asia we find the same causes in operation, though
perhaps not to so great an extent. There the soil is more
under cultivation, and there are high mountain lands in
the interior which are as healthy as any other regions in
the torrid zone.

Lind,f in speaking of this continent, says: "That the
countries which are well improved by human industry and
culture, such as China and several other places in that*
part of the world, are blessed with a temperate and pure
air salutary to the European constitution. On the other
hand, the woody and uncultivated parts of India, viz., the
islands of Java and Sumatra, the islands of Negrais, where
the English lately attempted to make a settlement, Banda
one of the Dutch spice islands, and several others, have
proved fatal to a multitude of Europeans and others who
have been accustomed to breathe a purer air. But in all
spots of the East Indies situated near the muddy and im-
pure banks of rivers, or the foul shores of the sea, the
vapors exhaling from the putrid stagnated water, either
fresh or salt, from large swamps, from corrupted vege-
tables, and other impurities, produce mortal diseases, espe-
cially during the rainy season."

The diseases which are peculiar to the unhealthy
portions of hot climates are of the same general type
throughout the world, being mainly those which are due
to malaria, but modified either in intensity or character,

* Sketches of the Medical Topography and Native Diseases of the
Gulf of Guinea, etc. London, 1849, p. 6.
f Op. cit., p. 76.

268 A TREATISE ON HYGIENE.

according to local circumstances. Thus, intermittent and
remittent fevers of aggravated form occur in the West In-
dies and other parts of tropical America. Yellow fever
prevails along the coast. Diarrhoea, dysentery, and liver
diseases are also common and severe in their character.
Dysentery is, according to Dutroulau,* the endemic disease
of tropical climates from which the greatest annual mor-
tality occurs; but this statement is not borne out by the
statistical reports of the British army, from which it would
appear that paroxysmal fevers give rise to more admissions
into hospital and more deaths at the generality of stations
in hot climates, garrisoned by British troops, than any
other class of diseases. Ewart,j* however, shows that in
India the deaths from diarrhoea and dysentery are more
frequent than from any other disease, but he also shows
the great predisposing cause of these affections to be mala-
rious fevers.

In tropical Africa malarious fevers and bowel affections
are met with in their most malignant phase.

In those parts of the United States which are south of
30° of north latitude, severe intermittent and remittent
fevers are encountered. Florida is peculiarly subject to
malarious diseases. The character of the soil, and the
absence of cultivation which prevail in the peninsula, call
to mind the descriptions given by Lind and other writers
of the west coast of Africa.

Cold Climates are those which prevail from 55° of
north or south latitude to the pole. In these regions there
is a very great range of temperature, and also very great
differences to be observed in respect to other meteorological
influences. Part of them are for a very considerable period

* Traite des Maladies des Europeans dans les Pays Chauds. Paris,
1861, p. 442.

f A Digest of the Vital Statistics of the European and Native Armies
in India, etc. Loudon, 1859, pp. 42 and 86. A

CLIMATE. 269

deprived entirely of the light and heat of the sun, and in
others oceanic currents, of comparatively high tempera-
ture, lessen the degree of cold which would otherwise
prevail.

According to the very extensive table prepared by M.
Mahlmann, it would appear that Melville Island has the
lowest mean annual temperature of any other place known
to man, the thermometer indicating as the mean for the
year 1-66°. The latitude of Melville Island is 74° 47'
north, and though more northern regions have been at-
tained, (Dr. Kane having passed two winters at Renssalaer
Harbor, latitude 78° 39' north,) it does not appear that the
average temperature for the year was lower than that
observed at Melville Island.

The most moderate temperature met with within the
limits embraced under the designation of cold climates, is
that which prevails in the north of Ireland and through-
out Scotland. And this fact is due to the circumstance
that these countries are surrounded by the ocean, the
water of which is rendered comparatively warm through
the influence of the Gulf Stream, which preserves its
elevated temperature till it reaches the shores of these
countries.

In regard to vegetation, considerable variation is ob-
served. In the localities within the limits in question
nearest the equator, though not profuse it is not scant, but
it is never of such a character as to exert any influence
over the health of man by its decomposition, as is the case
in the countries near the equator. As we proceed from
this line north or south, the luxuriance of vegetable
growth diminishes, until finally we arrive at regions where
nothing but a few lichens or mosses are to be found.

In Norway, in the valley of the Alten, at 70° north
latitude the soil admits of cultivation. In no other part of
the globe with this latitude is the earth tilled, and to the

270 A TREATISE ON HYGIENE.

influence of the Gulf Stream must be ascribed the isola-
tion of this spot from the concomitants of other localities
situated within the arctic circle.

In America at this latitude the climate is such as to
admit of the production of nothing beyond fucoid growths,
and in Siberia a similar condition exists.

The Danish settlements in Greenland are still farther
north, Upernavik at 72° 40' and Tessuissak at 73° 40'; but
though men are capable of maintaining themselves in
these inhospitable places, they are unable to procure from
the earth any portion of their subsistence. Even as high
as 78° of north latitude, Dr. Kane met with a tribe of
Esquimaux, entirely shut off from all communication with
the rest of the world, and numbering but a little over one
hundred persons.

To what are we to ascribe the stunted forms of the in-
habitants of these regions but to the degenerating influ-
ences of low temperature, deficient light, and insufficient
food? The struggle with nature for existence appears to
be constant; and yet when we come to examine into the
sanitary condition of these people, we really find very little
to exert an injurious action upon them except those causes
which arise from their own depraved habits of life. Mala-
rious diseases are unknown, phthisis is scarcely if ever
heard of. Civilization has not reached them, bringing in
its train a thousand ills that owe their existence to the
violation of the laws of hygiene. Though their huts are
reeking with filth, though in their personal habits they
have no idea of cleanliness, the emanations which would
otherwise be noxious are deprived of their injurious quali-
ties by the low temperature that prevails, and, save the
danger from cold and starvation, they are exposed to
scarcely any morbific influences. Those diseases which do
affect them are not of the sthenic type, and are limited to
low fevers, to which they are occasionally liable.

CLIMATE.

271

Hans Egede,* a missionary in Greenland for twenty-five
years, in a quaint description of that country, says : "The
temperament of the air is not unhealthful, for if you ex-
cept the scurvy and distempers of the breast, they know
nothing here of the many other diseases with which other
countries are plagued; and these pectoral infirmities are
not so much the effect of the excessive cold as of that nasty
foggish weather which this country is very subject to."

But those to whom the arctic climate is not natural bear
its rigors with great difficulty, and combat against a con-
stant tendency to break down under its depressing power.
At Kjevik in Norway, which is the most northern point
of Europe inhabited by civilized people, according to Mr.
Bayard Taylor missionaries coming there from southern
Norway die within the year, and half the inhabitants perish
annually of scurvy. Attempts have been made to colonize
Jan Mayen and Spitzbergen, but they were unsuccessful ;
and some Russians who were left at Spitzbergen for six
years died, with the exception of four, before the expiration
of the first winter.

It must not be forgotten, however, that this inability of
Europeans to exist for any length of time in arctic regions
is not altogether due to the influence of climate. It is the
result of the attempt being made without the mode of life
being adapted to the changed conditions under which the
organism is placed. Scurvy appears to be the disease
which is most fatal to arctic voyagers, and yet it is alto-
gether possible to prevent the occurrence of this affection,
as did my friend Dr. Hayes, now of the United States
Army, during his recent polar expedition. Dr. Hayes
attributes the entire freedom of his command from scurvy
to the fresh meat diet which he was able to obtain for his

* A Description of Greenland, etc. Translated from the Danish.
London, 1745.

272 A TREATISE ON HYGIENE.

men, and to the thorough ventilation of his vessel during
the winter, when the party were confined, to a great
extent, to this shelter.

In latitudes characterized by an extreme depression of
temperature the food must be essentially different from
that most in use by the inhabitants of tropical climates.
We know that one of the chief sources of the animal heat
is the oxidation of carbon and hydrogen in the blood and
tissues. In hot countries the inhabitants seldom eat meat
or fatty substances, their inclinations and instincts pointing
to the use of fruits and light farinaceous articles of diet.
Here any exertion of the organism to keep up its normal
temperature is unnecessary, for the atmosphere is almost
constantly possessed of such a degree of heat as militates
against the loss of any but a very small amount by the
body.

On the contrary, in cold climates the circumambient at-
mosphere is, as we have seen, frequently 150° below the
temperature of the body, which, therefore, is constantly
losing its heat to such an extent as would in a very short
time lead to death but for the character of the food used
by those who are subjected to this extreme degree of cold.

The well-marked variations which indicate the seasons
intermediate between winter and summer are not wit-
nessed in cold climates. In arctic or antarctic regions
summer and winter are the only two divisions of the year
which exist. On this account the great amount of sick-
ness which results in temperate climates from the change-
ableness of the weather is not met with in cold climates.

Thus we see that though the inhabitants of arctic and
antarctic regions evidence in their physical and mental de-
velopment the operation of the meteorological and telluric
influences to which they are subjected, so far as their indi-
vidual hygienic condition is concerned they are far more
favored than the dwellers in tropical climates, who are
surrounded with almost innumerable sources of disease.

• CLIMATE. 273

Temperate Climates. — The regions north and south of
the equator, extending from the thirtieth parallels of lati-
tude to the fifty-fifth, exhibit to some extent the charac-
teristics of climate belonging to both the torrid and the
frigid zones. In summer the heat in some localities rises
to as high as 105° Fahrenheit, and in others in winter
falls to 40°. Even in the same place the range of tem-
perature may be greater than is ever observed in the torrid
or frigid zones. Thus at Fort Kent in Maine, latitude
47° 15' north, the lowest temperature observed during
February, 1845, was 39°, while in July of the same year a
maximum point of 90° was reached, showing therefore a
range of 129°.*

In temperate climates the seasons glide almost insens-
ibly into each other, yet from day to day of any portion
of the year great variations are often experienced. In the
United States, for instance, it is not uncommon to experi-
ence a difference of thirty or forty degrees between the
temperature of one day and that immediately preceding
or succeeding it.

Temperate climates allow of luxuriant vegetation in
those parts nearest the equator, and even in those farthest
from this line the earth yields abundantly both for the
subsistence and comfort of man. During the spring, sum-
mer, and autumn, throughout nearly their whole extent,
malarious fevers prevail, and in the warmer portions as-
sume a malignant type, scarcely inferior to that met with
under the equator. But with the approach of winter dis-
eases of this character disappear, and do not originate
while the temperature remains below 32° of Fahrenheit.

In considering the peculiarities of temperate climates we
shall dwell particularly on that of the United States, not

* Army Meteorological Register for Twelve Years, from 1843 to 1854
inclusive. Washington, 1855, pp. 122, 142.

274 A TREATISE ON HYGIENE.

because it is a type of others of the same class, but on
account of the greater interest which attaches to it among
those for whom this book is mainly intended. So far from
the climate of this country being a standard by which to
judge those of other countries embraced within the same
parallels of latitude, it presents more variations, more in-
consistencies, than that of any other country on the face of
the globe.

The climate of the United States is colder than that of
European regions of the same latitude, but warmer than
places similarly situated in Asia. Thus the fortieth paral-
lel of north latitude passes through Philadelphia, and the
forty-first a few miles north of Naples. The mean annual
temperature of the former place is 54*57°, as determined
from observations extending over six years, while of the
latter it is 6206°, as deduced from observations continued
through eighteen years. The fortieth parallel also passes
through Pekin, but here the mean annual temperature is
but about 52°.

Fort Snelling, situated in latitude 44° 53' north, and but
eight hundred and twenty feet above the level of the sea,
has, as the mean of observations extending over thirty-five
and three-quarters years, an annual temperature of 44-54°,*
while Sevastopol, which is situated in latitude 44° 36', has
a mean annual temperature of 52-7°, and London, which is
in latitude 51° 31', nearly seven degrees north of Fort
Snelling, has an average annual temperature of 507°, or
nearly seven degrees above that of the latter place.

To account for the greater temperature of Europe, sev-
eral theories have been proposed : one of them ascribes the
difference to the greater extent to which the soil is culti-
vated, and doubtless this influences the result to some ex-
tent, but it is not sufficient to account for the great differ-

Army Meteorological Register, p. 632.

CLIMATE. 275

ence. More probable causes are to be found in the facts
that the prevailing winds of Europe come from the At-
lantic Ocean, and, being loaded with moisture, give out
their latent heat as the vapor they carry with them is con-
densed into rain, and that the Gulf Stream, rushing out of
the Gulf of Mexico, heated to over seventy degrees, sweeps
along the northern coasts of Europe and modifies the tem-
perature which would otherwise belong to these regions.

Moreover, on referring to the map it will be seen that
Europe extends north but to about the seventy-first de-
gree, and is then bounded by an open ocean; whereas
the continent of America extends as far north as the
eightieth degree, and is inclosed by a sea of ice. From
this region cold winds proceed, untempered by passing
over any intervening water, and reduce the temperature of
the whole of North America.

But if we take the western coast of the United States,
we find the climate very much modified in severity, and
more nearly comparable with that of the west coast of
Europe. Thus Fort Vancouver, in latitude 45° 36', has a
mean annual temperature of 52-65°, and Venice, in latitude
45° 26', an average temperature for the year of 56*6°, a
difference of only four degrees. Fort Steilacoom, in lati-
tude 47° 10', possesses a mean annual temperature of
5082°, and Baden-Baden, in latitude 47° 30', nearly the
same, 50'5°.

Upon examining the isothermal charts, prepared by Mr.
Lorin Blodget for the Army Meteorological Register, it will
be seen how the temperature lines change their latitude as
they pass across the continent.

As an example, take the line representing a mean tem-
perature for the year of 50°. Commencing at Fort Adams,
in latitude 41° 29', it proceeds in a direction generally
parallel to the equator, till it reaches the great sandy
plains of the eastern slope of the Bocky Mountains. It

276 A TREATISE ON HYGIENE.

now inclines to the north, and arrives at Fort Laramie, in
latitude 42° 12'. It now suddenly turns to the south, and
runs along the table-lands of the Eocky Mountains till it
reaches Las Vegas, in latitude 35° 35', having lost 5° 09'.
Crossing the mountain chains of New Mexico in a direc-
tion nearly due west, it abruptly turns to the north, and,
running in a direction about north-northeast, crosses the
fiftieth parallel, having gained 8° 51' of latitude since it left
Fort Adams, and having passed through 15° of latitude.

In regard to humidity the greatest difference exists. At
Fort Yuma, in the interior of California, the mean amount
of rain for the year is but three inches, while at Baton
Rouge in Louisiana, Fort Myers in Florida, and the
northern coast of Oregon, the quantity for the year is sixty
inches. On the dry and sandy plains of western Kansas
and New Mexico dew is never seen; in the eastern parts
of the country the air for weeks together is loaded with
moisture.

In the characters of the soil and in the geological forma-
tion, every variety is to be met with. In Florida, marshes;
in Louisiana, alluvium; in the Middle and Western States,
a rich humus; in New Mexico, sand, are the features
encountered.

In altitude above the sea, the whole surface of Florida
will not average fifty feet, while that of New Mexico
reaches to between four and five thousand.

In regard to the diseases which arise under these varied
conditions, the Medical and Statistical Reports of the Army,
prepared, from data furnished by the medical officers, by
Lieutenant-Colonel R. H. Coolidge, M.D., Medical Inspec-
tor, furnish the most extensive and reliable information,
and are well worthy the careful study of all those who
desire to understand the diseases to which our soldiers are
liable.

In Florida the ratio of cases of fever treated to 1000 of

CLIMATE.

277

mean strength was 2216, while in New England it was

but 114. In diseases of the organs connected with the

digestive system, Jefferson Barracks, St, Louis Arsenal, and

the east coast of Florida have the greatest ratio, and the

coast of New England the smallest. In diseases of the

respiratory system, New York, New England, and the

region about the great lakes exhibit the largest ratios, and

Florida, Texas, and New Mexico the smallest; while for

all diseases the south and west, as far as the Mississippi

Biver, exceed other portions of the country.

Another most interesting point settled by these statistics
is that relative to the influence of climate over phthisis.
The following table is so important in the indications
which it affords that I have not hesitated to transfer it
from the volume in which it originally appeared.*

Kegions.

Coast of New England ■

Harbor of New York

West Point

North interior East

The great lakes

North interior West

Middle Atlantic

Middle interior East

Newport Barracks, Kentucky

Jefferson Barracks and St. Louis Arsenal.

Middle interior West

South Atlantic

South interior East

South interior West

Atlantic coast of Florida

Gulf const of Florida. ■

Texas, southern frontier

Texas, western frontier

New Mexico

California, southern

California, northern

Oregon and Washington Territories

Mean
strength.

3963
9387
6901
3553

10,346
7230
6299
2456
1454
5580
5319
2800
5919

10,013
835
2299
4450
6324
5873
1707
1599
1831

Number
treated.

Katio of cases per
1000 of mean
strength.

4-8

5-9

0-8

4-7

4-5

4-1

2-5

2-4

3-4

5-2

9-2

7-2

2-3

6-9

1-8

5-2

3-2

* Statistical Report on the Sickness and Mortality of the United
States Army, from January, 1839, to January, 1855. Prepared by R.
H. Coolidge, M.D., etc. Washington, 1856.

278 A TREATISE ON HYGIENE.

From this table it is seen that with the exception of
West Point (which should be excluded, for the reason that
the cadets are young men who undergo a rigid physical
examination before they are allowed to enter the military
academy as students) the lowest ratio of cases of consump-
tion occurs in New Mexico, being only 1*3 per 1000, and
that the highest is in the South Atlantic Region, where it is
9-2 per 1000.

From a careful examination of the tables of temperature,
rain, and weather, which have been formed from data col-
lected by the medical officers, and considering them in
connection with the results exhibited in the foregoing
table, there can be no doubt relative to the correctness of
the conclusions arrived at by Dr. Coolidge.

"First. That temperature considered by itself does not
exert that marked controlling influence upon the develop-
ment or progress of phthisis which has been attributed to
it. If a high range of temperature were favorable to the
consumptive, the South Atlantic Region, the South Interior
East, and the Gulf Coast of Florida should exhibit a lower
ratio than the colder regions of the north and northwest,
whereas the contrary obtains; and again, if a high range
of temperature were the controlling element in causing an
increased ratio of this disease in the two southern regions
above named, we ought not to find a lower proportion of
cases in Texas, where the temperature is higher, nor in
the South Interior West, where it is nearly the same as in
the South Atlantic Region.

"Second. That the most important atmospherical con-
dition for a consumptive is dryness. An examination of
the rain tables will serve in part to elucidate this position,
and in part only, for the total annual precipitation in rain
and snow may be equal in two or more places, and yet the
annual condition of the air, as respects moisture — the
dew-point — may widely differ. It is impossible to repre-

CLIMATE.

279

sent all their distinctive features by statistical tables, but
the fact has been forcibly impressed upon the compiler
during the minute examinations necessary to the prepara-
tion of this report.

" Third. That next to dryness in importance is an equa-
ble temperature — a temperature uniform for long periods,
and not disturbed by sudden or frequent changes. An uni-
formly low temperature is much to be preferred to an uni-
formly high temperature. The former exerts a tonic and
stimulating effect upon the general system, while the latter
produces general debility and nervous exhaustion. The
worst possible climate for a consumptive is one with a long-
continued high temperature and a high dew-point."

From my own observation, I am able entirely to confirm
the deductions arrived at by Dr. Coolidge. I have known
several persons affected with phthisis pass the winter at
Mackinac with very decided advantage. The climate there
is cold and dry. The mean temperature of winter, as de-
duced from observations made during twenty-four years, is
20-03°, and for the whole year 40-65°. The mean quantity
of rain for the same season (snow being melted and meas-
ured as water) is but 3-31 inches, and for the whole year
but 23-87 inches; less than the average at any other mili-
tary station of the United States, except those situated
on the prairies west of the Mississippi and in New Mexico,
and some parts of California and Oregon. Under the influ-
ence of the climate of Mackinac, both in summer and win-
ter, I have witnessed all the symptoms of phthisis become
ameliorated or entirely disappear, at the same time that
the body improved in condition and strength. Of course,
in cases in which the disease was far advanced, the same
favorable results were not to be expected; but even here a
very marked improvement was manifested.

As the foregoing table shows, however, New Mexico is
by far the most favorable residence in the United States for

280 A TREATISE ON HYGIENE.

those predisposed to or affected with phthisis. Surgeon J.
F. Hammond* remarks, in his report on the Medical Topog-
raphy and Diseases of Socorro, that he had never seen but
two cases of phthisis in New Mexico. One of these was
that of an officer in the army, and the other of an American
emigrant. Both were affected before leaving the United
States, and both improved under the influence of the dry
and equable atmosphere of New Mexico.

In a service of three years in New Mexico, during which
period I served at eight different stations, ranging from the
extreme northern to the extreme southern part of that Ter-
ritory, I saw but three cases of phthisis, and these were in
persons recently arrived from the United States. Inflam-
mation of the lungs is also very infrequent, as are likewise
pleurisy and bronchitis.

Contrary to what would be expected, acute rheumatism
is quite a common disease in New Mexico, especially among
those who have emigrated from the United States.

Enough has probably been said to give the student some
idea of the variations of climate and the diseases to which
the inhabitants dwelling under each kind are peculiarly
liable. For fuller information on the subject, he is referred
to the work of the late Dr. Samuel Forry, U. S. Army, on
the Climate of the United States, to the several volumes
of Army Medical Reports, and to the works of Sir James
Clark, Mr. Edwin Lee, Sir Ranald Martin, and others.

* Army Medical Reports, from 1839 to 1855, p. 425.

ACCLIMATION. 281

CHAPTER XL

ACCLIMATION.

By acclimation we understand the process by which an
individual becomes naturalized to any particular climate to
which he is not accustomed. Through the change which
ensues, his system becomes assimilated to the type which
predominates among the natives of the region. He ac-
quires their peculiarities and immunities, and in fact, if
the act of acclimation is thorough, undergoes a change
both in his mental and physical organization.

That this process does take place, there can be no doubt,
so far as individuals are concerned ; but there are not
wanting those who contend that races never undergo com-
plete acclimation, that degeneration invariably occurs, and
that those nations who have colonized regions with dif-
ferent climates than those from which they originally
sprung, would inevitably become extinct but for the en-
grafting of new blood by emigration from the parent
countries.

There is no evidence to support this view. On the con-
trary, the whole history of the world is against it. It
needs but a superficial examination of the people of this
country or of England, for instance, to show its utter want
of foundation. The present inhabitants of the British Isles
are not autochthones, (abrdg, one's own, and x 0wv > land,
country,) and yet no one, we presume, would venture to
assert that they are physically or mentally inferior to those
of their neighbors who are original stocks. The present
inhabitants of the United States are of European descent,

282 A TREATISE ON HYGIENE.

and are mainly natives of the soil, the emigration not being
sufficient in a generation to make any decided impression.
In stature, in girth of chest, in powers of endurance, they
will compare favorably with the inhabitants of any country
in the world. In fact, as the result of over fifteen thousand
observations, embracing the chief points desirable in a col-
lection of vital statistics, I am enabled to assert that so far
as physical development is concerned, it is very doubtful if
any people in the world excel those of the Northern States.

Take, also, the instance of the Jews. Originating in
Eastern Asia, they have spread over the whole world,
assuming the type of organization peculiar to the people
among whom they fix themselves, but retaining their
physiognomy to such an extent that no one has any diffi-
culty in recognizing them.

But the ability to become acclimated is not possessed to
the same extent by all races. We have already seen that
the Caucasian race is pre-eminent among all others for its
capacity for colonization, and consequent power of adapting
itself to the peculiarities of climate. We see it in all parts
of the world, from regions of perpetual ice and snow to the
torrid zone where frost is never seen, able to combat suc-
cessfully the various climatic influences by which it is sur-
rounded, and to adapt its peculiarities of organization to
the new conditions, provided changes are made in the mode
of life, manners, and customs of those who essay the experi-
ment. This is the main point. For an Englishman or an
American to attempt a residence in latitude 80° without
varying his food, clothing, or habits, by making them con-
form to the climate to which he has come, would lead but
to one termination — death. But if he studies the conditions
by which he is surrounded, and profits by the experience
of those to whom they are natural, he becomes habituated
to the new state of things, and lives in health and comfort.

Instances of the truth of these propositions are not

ACCLIMATION. 283

wanting. Formerly expeditions to arctic or antarctic
regions lost many of their number from inattention to this
law, or ignorance of its existence ; but now they pass win-
ter after winter surrounded by ice, and with the thermom-
eter for months together at — 40°, without the loss of a
man, except by accident.

So, also, with those who change to a hot climate, the
same law holds good. Copland* states that when traveling
in intertropical Africa in 1817, he met with an English-
man who had lived there for between thirty and forty
years, and was then in the enjoyment of health. The cir-
cumstance appeared singular, and, in answer to inquiries,
the resident stated that soon after his removal to that pes-
tilential climate, his health continued to suffer, when, after
trying various methods without benefit, he had pursued as
closely as possible the modes of life of the natives, adopting
both their diet and beverages, and since that time he had
experienced no serious illness.

In the following passage from Levy,f this subject is so
well considered, that I translate it entire : —

" Has man sufficient organic flexibility to adapt himself
by turns to extreme influences of diverse orders, and thus
to flourish under all climates? Those who adopt this
opinion refer to the diffusion of the human species from
60° of south to 70° of north latitude. Man lives at
altitudes of 4101 metres, in deep excavations of the soil
under a pressure of the atmosphere superior to that at the
level of the sea. He has lived for a short time far above
this limit. Saussure in the Alps, Bonguer in the Cordil-
leras, have reached heights of about 6000 metres; Parry
and others have opened a way through the ice beyond 82°
of north latitude. Thus man exists in the midst of a tem-

* Dictionary of Medicine, vol. i. p. 409, art. Climate.
f Traite d'Hygiene, tome i. p. 563.

284 A TREATISE ON HYGIENE.

perature exceeding that of his own blood. He triumphs
over a degree of cold sufficient to freeze mercury. His
existence is not immediately endangered by a pressure less
than half of that which he supports at the surface of the
earth — at altitudes where water boils at 6 6 -66° Centigrade,
and under an atmospheric pressure equivalent to but half
of that which obtains at the level of the sea. Those who
refuse to man the faculty of living and of perpetuating his
species under all latitudes, affirm the multiple formation of
mankind, insist on the differences of races, and on the fatal
results which ensue on translating man from one climate
to another. Three hundred Germans sent to Cayenne in
1765 were reduced in less than three months to three indi-
viduals, of whom only one had escaped disease. Seven
hundred Frenchmen, deported to a district of Mexico by
M. Laisne de Ville-Levesque, lost in two years five hundred
and thirty of their number by death. According to Lind,
the new-comers in the Antilles, even when taking all
proper precautions, succumb in the proportion of one-fifth
every year. Dr. Twining, who has practiced a long
time in India, assures us that the influence of the climate
is such that in the peninsula of the Ganges the third gen-
eration of pure, unmixed Europeans does not exist. This
remark applies both to the English and the Portuguese.
Negroes resist a little better, but nevertheless perish very
rapidly. It is the same in Ceylon. From 1730 to 1752
more than a million of colonists perished in Batavia.
The English army loses in that country, and in time of
peace, 1*2 of 100 officers, and 1*7 of 100 soldiers. In the
Indies the same troops experience a mortality threefold
greater, according to a mean of three years, established by
M. Edmondre. In the English Antilles, the calculations of
MM. Marshall and Tulloch fix the proportion of deaths
among the troops at 1 in 24 ; it is increased in Senegal to
1 in 7. (Thevenot.) It would be very easy to multiply the

ACCLIMATION. 285

examples of this excessive mortality observed with indi-
viduals who have been transported to different countries ;
but all the facts of this kind, accumulated by statistics,
prove nothing against the aptitude which man possesses to
support very different climates ; for it is necessary to de-
monstrate that the mortality should be attributed exclu-
sively to the influence of climate. As to the extinction of
emigrants to the second or third generation, has it been the
certain consequence of the attempt at acclimation in inter-
tropical regions, or has it not rather been the general epi-
sode of attempts at colonization made without prudence in
countries of notorious insalubrity? Had the Europeans,
whose posterity has disappeared so rapidly before the
scorching atmosphere of the tropics, acquired (with the
evidences of a complete acclimation) the power to procreate
offspring adapted to the climate in which they were born ?
Before engendering new beings for a region in regard to
which they were inexperienced, had they undergone the
series of transformations which would enable them to live
there themselves? Had the children received the atten-
tion and the hygienic direction which the climate pre-
scribes ? What has been the hygiene of the colonies
thrown without care from Europe to the Antilles ? What
is to be conceived of the deplorable condition of the emi-
grants whom misery drives in crowds from their native
soil, and who, from the time of their embarkation for their
distant destination, suffer under the pangs of nostalgia and
from the fatigues and deprivations of a long voyage?
Who does not know the excesses, the singular eccentrici-
ties, the injurious customs which lie heavy on the life of
the English in India ? Johnson draws the picture, worthy
of pity, which they present : imprisoned by a tyrannical
custom in the vice of their tight-fitting uniforms, they are
inundated by the floods of sweat which pass through their

clothing."

286 A TREATISE ON HYGIENE.

In considering further the subject of acclimation, it will
be proper to discuss it under two heads — as it is con-
nected with the removal of individuals from a cold to a
warm climate, and its relations to the change from a warm
to a cold region. The food which an individual should
ingest, the drinks which he should imbibe, when he is sub-
jected to a change of climate, will be mentioned briefly;
the full consideration of food in all its bearings being re-
served for another division of this treatise.

1st. Tlie acclimation of individuals removing from a cold
or temperate to a liot climate.

It is necessary, in the first place, that we should per-
fectly understand the primary physiological effect produced
upon the human constitution by passing from a cold to a
hot climate.

In the inhabitants of cold regions the vital functions are
maintained in a highly active condition. The heart beats
full and strong, in order to force the warm blood through
every part of the body, and thus to preserve the animal
temperature at its proper point. The respiratory process
is also conducted with energy; digestion is promptly per-
formed; the kidneys are active in removing the effete mat-
ter which, from the vigorous manner in which the organs
act, is formed in great amount. The whole organism is
thus adapted in its functional operations to the condition
of climate under which it exists.

Transfer a person whose system has become habituated
to a cold climate to one that is torrid in its character, and
he is at first unsuited for the new conditions which sur-
round him. It is not necessary that his circulation and
respiration should be as active as before. The tempera-
ture of the air is as high as that of his body, and conse-
quently, even if life were to become extinct, the ther-
mometer placed in the cavity of his chest would stand at
the point indicating the temperature of the circumambient

ACCLIMATION. 287

air. There is therefore a surplus of action in the functions
of circulation and respiration. But there is no excess in
actual results. The hot and moist atmosphere is calcu-
lated to interfere with the due performance of those
changes which are carried on through the respiratory pro-
cess, and the products of tissue metamorphosis, which were
removed to a great extent from the system by the lungs,
are either retained in the body or thrown upon the liver
for excretion. This organ therefore becomes disordered.
To perform the increased amount of labor which it has to
undertake, it becomes enlarged, in accordance with a well-
established law of the economy.

The skin, which in cold climates ordinarily performs its
function insensibly, becomes very active ; the kidneys, on
the contrary, excrete less than previously.

Through the increased action which ensues in the func-
tions of the liver a large amount of bile is poured into the
alimentary canal, to give rise to intestinal diseases, or to
be reabsorbed into the economy, causing fever and other
forms of constitutional disturbance.

Food. — If, in addition to these perfectly natural causes of
disordered action in the organism, food and drink, such as
the individual may have been accustomed to, is now in-
dulged in, the disturbance is very much increased. All
writers on the diseases of warm climates insist upon the
absolute necessity of temperance. Mosely* says, in speak-
ing of the climate of the West Indies: "On first arriv-
ing, though the use of the necessaries of life and the
natural gratification of natural desires are by no means
interdicted in hot climates, yet every excess is dangerous ;
and temperance in all things is necessary to be observed
by men, women, and children. For youth, abstemiousness
for awhile is the best security against illness."

* A Treatise on Tropical Diseases. London, 1188, p. 13.

288 A TREATISE ON HYGIENE.

Iind* refers to the irregularities of young people wh.
go to the East or West Indies as one of the principal
causes of the sickness to which they are subject. "For,"
as he says, "if those who are newly arrived at Jamaica
drink immediately of hot, new-distilled rum, they will un-
avoidably fall into a violent fever; if they commit any
excess in eating fruits, they will have a flux; or if they
load their stomach with indigestible food, they will have a
cholera morbus or a vomiting, which may carry them off in
a few hours."

M. Aubert-Rochef also observes that diarrhoea, dysen-
tery, and hepatitis occurring in Europeans are mostly
traceable to errors in diet. Habituated to the use of wine
and other stimulants, they persevere in drinking them, or
substitute arrack in their place. Ignorant of the effects of
alcoholic drinks in warm countries, oppressed by the heat,
and weakened by the excessive cutaneous transpiration,
they drink and expect to restore their strength by fre-
quent potations. But so far from being a tonic under
these circumstances, alcohol acts as an irritant to the
stomach, and an exciter of those very actions which, as
has been seen, are already performed with too much
energy. Even in cold climates alcohol, when used to ex-
cess, acts injuriously upon the liver, and in hot countries
its influence is still more prejudicial. DutroulauJ also
calls attention to the injurious results of over-eating. He
says that excesses of the table -are those which the newly
arrived European in hot climates should take most pains
to avoid. Regularity of regimen is the first means which

* An Essay on Diseases incidental to Europeans in Hot Climates, etc.
London, 1768.

f Essai sur l'Accliraatement des Europeens dans les Pays Chauds
Ann. d'Hygiene, 1845, tome xxxiii. p. 25 et seq.

X Traite des Maladies des Europeens dans les Pays Chauds. Paris
1861, p. 123.

ACCLIMATION. 289

he should employ in order to aid the stomach in passing
through the modifications which it is obliged to undergo.
His drink, if he takes any alcoholic liquor at all, should
be wine and water. It is doubtful if pure red wine, taken
with moderation, can be considered hurtful.

Don Abel Victorino Brandin,* in an excellent little
work, is very specific on this point, and being himself an
inhabitant of the torrid zone his opinions possess additional
value. According to this author, one should eat less in
hot than in cold climates, and excesses in this direction
are more dangerous in the former than in the latter.

Almost all writers on the diseases of hot climates recom-
mend the use of coffee as a beverage.

In general terms, Europeans emigrating to hot climates
should avoid the ingestion of any substances calculated to
disorder the action of the stomach or other viscera con-
cerned in the function of digestion. Their food should be
unstimulating, and, as far as practicable, should be analo-
gous to that of the residents of the region. Fruits and
amylaceous substances are those which experience has
found to be most beneficial, the former at first being used
moderately. Acid drinks, unless used in small quantity,
are injurious, as tending to induce intestinal disturbance.

Troops on service in hot climates should be guided by
similar principles. If possible, fresh meat should be issued
at least three times a week; alcoholic liquors should be
altogether interdicted, and the use of coffee encouraged,
especially in the morning. Fortunately there is no neces-
sity for insisting on the advantages to the troops of coffee
as a beverage. It is always provided for them, and is gen-
erally of good quality. Tea is also an excellent drink,
and produces results analogous, though not identical, with

* De la Influeucia de las differentes Cliraas del TJniverso sobre el
Hombre. Lima, 1826, p. 110.

290 A TREATISE ON HYGIENE.

those caused by coffee. This subject is reserved for further
consideration under the head of aliments.

Exercise. — Much physical exercise is injurious to those
newly arrived in hot climates. Aside from the exposure
to the heat of the sun, or to the noxious night air which it
generally necessitates, it is debilitating until the system
has become habituated to the altered relations in which it
is placed.

Mosely,* in alluding to this subject, asserts that disci-
pline should never be of that character or degree to exceed
the proportion of exercise which is conducive to health.
A soldier should be nursed. All drudgery should be per-
formed by negroes and others inured to the climate; and a
soldier should be allowed to perform no exertion until
some important point is to be carried into execution.
Drills should be in the morning before the sun has ac-
quired its full power, but not until it has risen sufficiently
high to dissipate the noxious emanations which have been
given off from the earth during the night.

Work requiring the turning up of the soil is, for the
reasons stated under the head of malaria, especially preju-
dicial. With troops, however, it is not always possible to
avoid those labors which are often dictated by a military
necessity.

At the same time idleness should not be tolerated.
Nostalgia, which has its most frequent cause in habits of
idleness, is one of the chief occurrences to guard against in
acclimation. Moderate exercise is to be encouraged, both
as being beneficial to the body and the mind, but it should
be of such a character as not to produce fatigue. At gar-
risons, games in the open air, toward sundown, (not after,)
afford means of amusement, and of providing sufficient
physical exercise.

* Op. cit., p. 133.

ACCLIMATION". 291

Clothing. — The clothing should be light, and at the
same time sufficiently fine in texture, and of such a char-
acter as to prevent the too rapid refrigeration of the body
during the cool nights which so frequently, in warm cli-
mates, ensue upon the excessively hot days. Flannel
worn next the skin is very useful, acting both as a mod-
erator to the body and the atmosphere, preventing the
former losing its heat too rapidly, and also from becoming
overheated. Men who wear flannel underclothes can en-
dure much more fatigue than those who make use of no
such protection. I have witnessed many instances of the
truth of this assertion, and also of the fact that men wear-
ing flannel immediately next the skin are not so liable to
the diseases ordinarily attending acclimation, such as dys-
entery, diarrhoea, malarial fevers, etc., as those who do not.
Mosely* states that Dr. Irving, with a small party of
men, lay in the woods on the Mosquito shore for fourteen
days and nights, during the rainy season of 1780, without
taking off his clothes, while he was exploring a passage to
the Spanish settlements up Bluefields River. He escaped
without the least injury to his health, having blankets
with him, and being clothed in a shirt, short jacket,
breeches, and stockings, all made of flannel. The others,
not using the same clothing, suffered severely, without
exposing themselves to the same fatigue or danger.

The United States troops are furnished with flannel
shirts, and it would be well if the drawers were made of
the same material. The thick blue cloth coats and trow-
sers are not suited to warm climates; neither is the cap
which is now worn at all adapted to service, either in hot
or cold regions. In the Southern States, broad-brimmed
straw hats should be issued for summer use, as was done
last summer at Hilton Head by Major-General Hunter.

* Op. cit., p. 132.

292 A TREATISE ON HYGIENE.

The British troops in the West Indies are, I believe, at
present clothed in white duck through the hot season.
The subject of clothing, in all its details, will be more
fully considered hereafter under its proper head.

Baths. — Owing to the great activity in the excretory
function of the skin, and the consequently increased amount
of matter left upon its surface, baths are even more ne-
cessary to health than in temperate climates. At first
they should be tepid, and the temperature should be grad-
ually lowered till the point of 75° or 80° is reached. They
should be taken in the morning before breakfast, according
to the rule already laid down. The cold bath, aside from
its cleansing properties, is one of the best means of fortify-
ing the system against the diseases to which recent comers
to a hot climate are liable.

Localities. — There are generally to be found some places,
even in the most unhealthy climates, which, if not alto-
gether healthy, are at least more so than others. These
should always be taken advantage of for the location of
barracks, camps, or hospitals. Many lives have been lost
by a stubborn adherence of the British authorities to loca-
tions notorious for their insalubrity, and which had been
over and over again reported by the medical officers as
exposed to the most noxious influences, when other and
healthier places, equally advantageous in a military point
of view, were at command.

From a neglect of the precautions specified, thousands of
lives have been sacrificed which might have been otherwise
preserved. The care of the health of the troops should
certainly be one of the first duties of a military commander.
Unless his men are in good physical condition, they can be
of no service to him in carrying out the objects he may
have in view, but are a hinderance to him and a burden to
themselves. And yet how often it happens that those in
command are heedless of the warnings and inattentive to
the advice given by their medical officers !

ACCLIMATION. 293

The Crimean war taught a lesson to the British Govern-
ment which it has not been slow to profit from, and which,
although it has proved advantageous to us, we might still
further appropriate to ourselves. When an English army
goes to a foreign climate, an officer of the medical depart-
ment is specially assigned to duty with it as sanitary offi-
cer. It is the duty of this officer to advise the commander
on all questions affecting the health of the troops. He has
nothing else to do but to attend to this duty.

During the late expedition to the north of China an op-
portunity was afforded for carrying out the regulations pre-
viously framed relative to the sanitary officer. Dr. Ruther-
ford, Deputy Inspector-General of Hospitals, was assigned
to this duty, and, if we may judge from his report,* per-
formed it with credit to himself and advantage to the force
with which he served. To Lord Herbert, who, when he
died, was Secretary of State for War, the medical depart-
ment of the British army owes much of the progress which
has characterized it since the war with Russia, and his
influence has been felt far beyond the limits of his own
country.

Acclimation, when thoroughly perfected, assimilates the
individual to the indigenous inhabitants of the soil in the
peculiar type of his organism. His system has undergone
some change by which he has become possessed of certain
attributes in place of others which he has lost. The num-
ber of years required to effect this reorganization varies
according to the latitude ; a longer time being required in
proportion as the region is nearer to the equator.

In military affairs, it is of course desirable to take ad-
vantage of this faculty of becoming acclimated, and to
change the troops in service in hot countries as seldom as

* Statistical Sanitary and Medical Reports of the British Army for
the year 1860. London, 1862, p. 291.

294 A TREATISE ON HYGIENE.

possible. A better plan is to follow the system adopted by
the English Government, and to garrison stations in hot
climates with troops raised in great part from the inhab-
itants of the countries where they are situated. In sending
troops to a hot climate, the best season for their arrival is
at the commencement of winter, as then a longer time is
afforded, before the beginning of the sickly season, for
the system to become gradually habituated to the ordinary
influences.

The permanent effects of change from a cold to a hot
climate, if fully discussed, would lead us into the realm of
ethnology. It will be sufficient if we merely point out some
of the more prominent changes which ensue after several
generations are exposed to the effects of a residence in a
hot climate.

The heat and light of the sun change the color of the
skin and hair, rendering the one black and the other nearly
so. There are also other changes effected through the
long-continued influence of these agents, as well as by the
increased moisture, the different food, the entire change in
the mode of life, which are accompaniments of a hot
climate. None of these are, however, of such a character
as to cause a race of men to lose their identity. The Jews
of India are almost black; those of Europe assimilate, in
the colors of their hair, eyes, and skin, to those of the
nations among whom they live. But the form of the
cranium and the peculiar physiognomy are preserved, so
that, notwithstanding the color, it is very easy to recog-
nize a Jew by these last-named characteristics. As to the
lengthening of the arms, the flattening of the calcaneo-
tarsal arch, the backward prolongation of the os calcis, the
curvature of the tibia, etc., there is no evidence to show
that they are at all due to the effect of climate. They
are typical characteristics of the races in which they are
found.

ACCLIMATION. 295

It has been too much the fashion to attribute all the dif-
ferences which exist among men to the effects of climate.
This is most illogical. We know that climate will effect
many changes; but we know tolerably well what those
changes are. The history of the past is written both in
the monuments of the historic and the pre-historic man, and
no fact is more indubitably established than that of the
invariability of types. In non-essentials, such as the color
of the skin and its appendages, there is variety; but in all
the essential characters, such as the form of the cranium,
the shape and size of the features, and the mental organi-
zation, climate exercises but little influence.

Those who deny the capacity of man for acclimation,
appear to forget that nearly all our domestic animals are
not indigenous to European or American soil. Why they
should admit that the horse, the dog, the cat, the ass, the
hog, and others, have been brought from climates far dif-
ferent from those under which they now flourish, and
refuse to allow the same power of adaptation to man, is
difficult to understand. So also with our vegetables and
fruits ; many of those which we prize most being originally
natives of other climates. The acclimation of plants is of
course more difficult than that of animals, as the character
of the soil is to be taken into consideration, as well as the
meteorological influences. When discussing the subject of
race, several instances of the acclimation of plants were
brought forward, and the list might be very greatly ex-
tended.

The effects of climate on man are limited therefore
mainly to certain external characteristics which are not
essential points in the determination of race. As Fredault*
observes the color of the skin is an accessory, not an essen-

* Traite de Anthropologic Physiologique et Philosophique. Paris,
1863, p. 75.

296 A TREATISE ON HYGIENE.

tial feature, and consequently does not suffice to distinguish
races. In fact, color does not change the nature of the
individual; and every one knows very well that a horse is
always a horse, whether it be white or black ; that a black
dog is as much a dog as -one that is white, and so on with
many other examples that might be cited. In fact, zoolo-
gists are beginning to understand that they have exagger-
ated the importance of external markings in determining
theories, and have too much neglected the peculiarities of
organization and of internal structure.

2d. The change from a warm or temperate to a cold climate.

It is much less frequently that we are called upon to lay
down rules for observance in changing from a warm to a
cold climate. The tide of emigration generally sets in an
opposite direction, and, save for the guidance of those who
are actuated by the spirit of adventure consequent on scien-
tific research, it rarely ever happens that advice is asked
for in regard to this variety of acclimation. But the sub-
ject is not the less important in its bearings on the hygiene
of armies, which go where they are ordered, and which
have frequently suffered by the neglect of proper sanitary
measures when on service in cold climates.

The condition which follows on passing from a warm or
temperate climate to a cold one is the reverse of that pre-
viously described as ensuing under opposite circumstances.
Instead of being oppressed by the excessive action of the
circulatory and respiratory organs, and bathed in the per-
spiration excreted by the skin, these functions are per-
formed with much less vigor than the system requires,
though the heart and lungs are taxed to their utmost to
respond to the wants of the organism. The kidneys, on
the other hand, have their function increased, at least so
far as relates to the removal of water from the blood.

Now the effects upon the health which result from the
change, though more gradually manifested than those pro-

ACCLIMATION. 297

duced by a hot climate, are not less certain or ultimately
less strongly marked. The disease which proves most fatal
to arctic explorers is scurvy, and this affection has mainly
owed its ravages among them to a disregard on their part or
an ignorance of the necessity for complying in all respects
with the requirements exacted of them in consequence of
the altered circumstances in which they were placed. To
enter the arctic circle, or even a much lower degree of lati-
tude, without changing the habits and mode of life, is as
certainly productive of disease and death as is similar
neglect under opposite relations in the torrid zone. Yet
with proper precautions, and by taking an intelligent and
physiological view of the surrounding conditions, it is as
practicable to exist without disease within the arctic or
antarctic circle, as midway between either and the equator,
and far more so than within the tropics.

In considering this subject we shall take extreme lati-
tudes as types of cold climate, premising that what applies
to them is also applicable, though of course with less force
and to less extent, to climates more moderate than those of
the polar regions, but yet sufficiently removed from the
equator and possessed of a low enough average temperature
to entitle them to be classed as cold climates.

Food. — The original inhabitants of the frigid zones live
entirely on animal food. They never have scurvy, and, as
we have already said, are liable to but few diseases. The
first explorers of polar regions failing to profit by the ex-
amples before them, ate salt meat and such vegetables as
they were enabled to carry with them, and suffered se-
verely from scurvy; many of their numbers perishing of
this disease. Even the Russians of Siberia, according to
Admiral Von Wrangel,* have neglected, after many years'

* Narrative of an Expedition to the Polar Sea, etc. London, 1844,
p. 13.

298 A TREATISE ON HYGIENE.

observation, to pattern after the native tribes, and are con-
sequently debilitated by disease and suffering. The Iakuts,
one of the aboriginal tribes, live on sour cows' milk, mares'
milk, beef, and horse flesh. They boil their meat, but
never roast or bake it, and bread is unknown among them.
Fat is their greatest delicacy. They eat it in every pos-
sible form — raw, melted, fresh, or spoiled. Farther north
the inhabitants do not cook their food, and on this fact
depends to a great extent their immunity from scurvy.

Dr. I. I. Hayes* states that the Esquimaux live upon
an exclusively animal diet, their daily allowance of food
being from twelve to fifteen pounds, about one-third of it
being fat — the blubber mainly of the walrus, the seal, and
the narwhal. In times of plenty they eat more than that
quantity at a single meal, devouring as much as ten pounds
of walrus flesh and blubber.

All arctic voyagers speak of this immense consumption
of animal food to which the Esquimaux accustom them-
selves. Dr. Hayes further says: —

"It is in his generally large consumption of food that
the Esquimaux hunter finds his shield against the cold ; I
do not believe that he could live upon a vegetable diet.
Taste, with the pleasures which it brings, has very little
to do with his meal; and he takes food through his capa-
cious jaws with much the same passiveness as that of a
locomotive upon receiving coal from the shovel of a fire-
man; and the cases are parallel. In the latter the carbon-
aceous coal is burned up in the furnace to make heat to
make steam to start the wheels. In the former the car-
bonaceous blubber and flesh are burned up in the lungs to
make heat to make steam to start the hunt. Feed the
locomotive on willow twigs, and on a frosty morning it will

* An Arctic Boat Journey in the Autumn of 1854. London edition,
p. 257.

ACCLIMATION. 299

be very likely to cease its operations ; feed the Esquimaux
hunter on wheat bread or macaroni, and he will quickly
freeze to death.

"The same laws govern the Esquimaux and the white
men; and exposed as we were to temperature so low,
living chiefly in an atmosphere varying from zero to the
freezing point, and subjected during a part of the day to a
temperature ranging from zero to sixty degrees below it,
we found ourselves continually craving a strong animal
diet, and especially fatty substances. The blubber of the
walrus, the seal, and the narwhal was always grateful to
us ; and in its frozen condition it was far from unpleasant
to the taste. I have frequently seen the members of our
party drink the contents of our oil kettle with evident
relish. *********

"In view of this fact, I think I hazard nothing in say-
ing that probably no climate in the world has less tendency
to develop scurvy than that of the arctic regions, provided
that the proper kind of food is used by the residents in it.
This food must be chiefly animal, largely fat, abundant in
quantity, and mainly free from salt. The Esquimaux are
exempt from the disease, although they disregard all of
our ordinary hygienic laws ; and I am satisfied that with
our present knowledge and experience scurvy need not be
the formidable scourge which it was in former times, if
indeed it need be known at all on board of vessels win-
tering in the arctic seas. Altogether the climate is one of
remarkable healthfulness, for were it otherwise, living as
we did in our close hut, we must have been attacked by

disease."

In a paper read before the Biological Department of the
Academy of Natural Sciences of Philadelphia, Dr. Hayes*

* Proceedings of the Academy of Natural Sciences, Biological Depart-
ment, 1859, p. 9.

300 >^ A TREATISE ON HYGIENE.

again discusses this question, and contributes a number of
interesting facts to it. In regard to the scurvy, he again
attributes its occurrence to the use of a salt-meat diet, and
^f^SlTY Of ^ co ^5 darkness, and excessive exertion, as accessories.

was owing to their weakened condition, resulting from
the use of salt food, together with the influence of cold
and darkness, that Dr. Kane's men were afflicted with an
epilepto-tetanoidal disease, with which the dogs, from like
causes, likewise suffered.

Alcohol, used habitually in large quantities, is doubtless
injurious. Dr. Hayes regards it as prejudicial under any
shape. On the other hand, tea and coffee are most useful.
The English and Russians prefer tea; while Dr. Kane's
men took most kindly to tea in the evening when re-
tiring, and coffee in the morning when preparing for a
day's journey.

In regard to cooking the animal food digested by arctic
voyagers, it would appear, as the result of all experience,
that it is more nutritious and a better anti-scorbutic when
eaten raw. Dr. Hayes has frequently found that the
stomachs of scorbutic patients which rejected the cooked
meat, retained the raw. By freezing, the repulsiveness of
raw meat is entirely destroyed. It is well known to phy-
sicians that raw meat is far better borne by the stomachs of
children laboring under cholera infantum than meat which
is cooked. In his recent voyage to the arctic regions, Dr.
Hayes and his men lived entirely on fresh meat and tea
and coffee, without the occurrence of a single case of
scurvy among them.

On the other hand, take the instance of the Dutch sailors
who, about the year 1636, spent a winter on Jan Mayen.
Huts were built for them, and having been furnished with
an ample supply of salt provisions, they were left, seven in
number, to solve the problem as to whether or not human
beings could support the severities of the climate. I quote

ACCLIMATION.

301

from Lord Dufferin* the story of their sufferings, mostly in
the language of the last survivor of the devoted band.

"'The 26th of August our fleet set sail for Holland, with
a strong northeast wind and a hollow sea, which continued
all that night. The 28th, the wind the same; it began to
snow very hard ; we then shared half a pound of tobacco
betwixt us, which was to be our allowance for a week.
Towards evening we went about together to see whether
we could discover anything worth our observation, but
met with nothing.' And so on for many a weary day of
sleet and storm.

"On the 8th of September they 'were frightened by the
noise of something falling to the ground;' probably some
volcanic disturbance. A month later it becomes so cold
that their linen, after a moment's exposure to the air, be-
comes frozen like a board. Huge fleets of ice beleagured
the island; the sun disappears; and they spend most of
their time in 'rehearsing to one another the adventures
which had befallen them by sea and land.' On the 12th
of December they kill a bear, having already began to feel
the effects of a salt diet. At last comes New Year's day,
1636. 'After having wished each other a happy new year,
we went to pravers, to disburden our hearts before God.'
On the 25th of^February (the very day on which Wallen-
stein was murdered) the sun reappeared. By the 22d of
March scurvy had already declared itself. 'For want of
refreshments we began to be very heartless, and so afflicted
that our legs are scarce able to bear us.' On the 3d of
April, 'there being no more than two of us in health, we
killed for them the only two pullets we had left; and they
fed pretty heartily upon them, in hopes it might prove a
means to recoverthe^trength ^ We were sorry we had

* Letters from High Latitudes. Being some Account of a Voyage
in the Schooner Yacht Foam to Iceland, Jan Mayen, and Spitzbergen,

in 1856. London, 1857, p. 154.

302 A TREATISE ON HYGIENE.

not a dozen more for their sake.' On Easter day Adrian
Carman, of Schiedam, their clerk, dies. 'The Lord have
mercy upon his soul, and upon us all, we being very sick.'
During the next few days they seem all to have got rapidly
worse; one only is strong enough to move about. He has
learnt writing from his comrades since coming to the
island, and it is he who concludes the melancholy story.
' The 23d of April the wind blew from the same corner
with small rain. We were by this time reduced to a very
deplorable state, there being none of them all, except my-
self, that were able to help themselves, much less one
another, so that the whole burden lay upon my shoulders,
and I perform my duty as well as I am able as long as
God pleases to give me strength. I am just now a-going
to help our commander out of his cabin, at his request, be-
cause he imagined by this change to ease his pain, he then
struggling with death.' For seven days this gallant fellow
goes on 'striving to do his duty,' that is to say, making
entries in the journal as to the state of the weather, that
being the object their employers had in view when they
left them on the island; but on the 30th of April his
strength too gave way, and his failing hand could do no
more than trace an incompleted sentence on the page.

"Meanwhile succor and reward are on their way to-
ward the polar garrison. On the 4th of June up again
above the horizon rise the sails of the Zealand fleet; but
no glad faces come forth to greet the boats as they pull to-
ward the shore; and when their comrades search for those
they had hoped to find alive and well — lo ! each lies dead
in his own hut, — one with an open prayer book by his
side; another with his hand stretched out towards the
ointment he had used for his stiffened joints ; and the last
survivor with the unfinished journal still lying by his
side."

From what has been said we can easily see how readily

ACCLIMATION. 303

man can adapt himself to the rigors of a polar winter; how
he can preserve his health, both bodily and mental, by
making his food conform in quality and quantity to the
conditions so different from those to which he has been
accustomed. And we also see how, when he attempts to
carry into a different climate the habits of life peculiar to
another, disease and death surely and speedily overtake him.
The general principles which we wish to bring promi-
nently forward are these: that in cold climates the food
should be mainly animal, that it should be fresh, and that
it may properly be ingested in quantities which, if taken
in warm climates, would certainly cause disordered func-
tional action. It would be well therefore for the good of
troops serving in cold regions that these points should engage
the attention of those having the charge of this matter.

In regard to alcohol, the united testimony of arctic
voyagers is decidedly against it. And yet there appears
to be an instinct in the' inhabitants of high latitudes
to indulge in the use of it. Everest* cites the habits of
the people of northern Norway as being very bad in this
respect, and the same may be said of all northern nations
who have among them the materials for the manufacture
of intoxicating liquors, or who know how to obtain such
beverages.

Exercise.— -The necessity for exercise in cold climates is
greater than in any other. The principal element that
man has to contend against is the low temperature, and
exercise, by increasing the extent of the chemical changes
going on in the body, at the same time causes a greater
development of heat. The advantages of exercise have
been recognized by all arctic explorers as a powerful pre-
ventive of scurvy.

* A Journey through Norway, Lapland, and part of Sweden, etc.
London, 1829, p. 80.

304 A TREATISE ON HYGIENE.

Clothing. — The clothing should of course be adapted to
the requirements of the climate. Reindeer skins are more
generally used, and even the face requires to be protected
from the intense cold which so commonly prevails.

CHAPTER XII.

HABITATIONS.

Men construct habitations for shelter, for isolation, and
for various special objects incident to a civilized condition.
A building of any kind intended for mankind to live
in, has necessarily connected with it some objectionable
features. It incloses a certain amount of air which is shut
off from the external atmosphere ; it excludes a large propor-
tion of the light which is so necessary for the well-being
of the human organism ; it brings its residents into closer
contiguity than if they simply dwelt upon the soil, and
hence allows of their becoming diseased through the emana-
tions from their own bodies; it requires (in cold or tem-
perate climates at least) to be heated, and this process, as
it is ordinarily conducted, is another source of disease ; it
is illuminated at night, which gives rise to additional con-
tamination of the air confined within the structure; and
it must be furnished (in civilized countries) with drains,
which are rarely constructed as they should be.

Now the object is to reduce all these causes of insalu-
brity to the lowest possible minimum consistent with the
retention of the essential characteristics of a house. It
would be easy enough to get rid of them all by living in
the open air, but by so doing, other factors would be
brought into action far more injurious in their operation

HOSPITALS. 305

than those we have cited. The house is the great essen-
tial of civilization: without it man would be a savage
again. It is infinitely better therefore that we should
tolerate the concomitants mentioned, or, what is still pref-
erable, seek, by the study of their relations and the laws
by which they are governed, to lessen, even if we cannot
entirely prevent, the injurious effects which result from
their operation.

Leaving out of special view the consideration of the hy-
giene of structures intended for certain particular purposes,
such as theaters, manufactories, and public buildings of
various kinds, and which properly belong to the domain of
public hygiene, we shall confine ourselves to the sanitary
principles which should govern in the situation, construc-
tion, and hygienic management of hospitals, barracks, and
encampments, though it will be found that the views enun-
ciated are applicable, with greater or less force, as the case
may be, to buildings of all kinds.

CHAPTER XIII.

HOSPITALS.

It is especially necessary that the utmost care should be
taken to secure every hygienic advantage in the location
and construction of hospitals. Unlike other habitations —
with the exception of prisons — the inmates are incapable
of going out to obtain fresh air and light. They must sub-
mit to the conditions in which they are placed, and if these
are such as are inconsistent with the requirements of sani-
tary science, the evil falls upon them with much greater
force than upon those able-bodied persons who, though

306 A TREATISE ON HYGIENE.

they may reside in insalubrious habitations, are within
their walls but a small portion of the day.

Moreover, in hospitals numbers of sick persons — some-
times several hundred or even thousand — are brought to-
gether, affected with every imaginable disease or injury,
and oftentimes with their bodies and clothing contami-
nated with the excretions and other filth which have accu-
mulated or been absorbed through their neglect of the
simplest habits of cleanliness, and thus influences are at
work tending still further to add to the pathological con-
ditions in which the inmates are placed.

So far as hygiene is concerned, no difference exists in the
requirements for civil and military hospitals ; both classes
are subject to the same general sanitary laws, and the in-
mates of both are entitled to equal consideration from
those who are placed in charge of them. But it will, on
many accounts, be more to the purpose to refer more par-
ticularly to military hospitals in the remarks to be made
under this head, though I shall not hesitate to bring for-
ward such examples of excellent civil hospitals as may tend
to illustrate any point under discussion.

Location. — Great pains should be taken to insure healthy
locations for hospitals, and also to secure advantages in
other respects, such as seclusion from noise and bustle,
facility for the supply of water and gas, accessibility, etc.
If these latter points can be provided for, hospitals are bet-
ter situated out of town than in the midst of crowded por-
tions of large cities, which are always more unhealthy than
the country.

The neighborhood of manufactories, from which noxious
vapors are evolved, or of places in which decomposition of
animal or vegetable matter is going on, such as slaughter-
houses, tanneries, manure factories, market-houses, grave-
yards, etc., should be scrupulously avoided. During the
war in the Spanish Peninsula the sick in the hospitals at

HOSPITALS. 307

Ciudad Rodrigo were affected with dysentery, hospital gan-
grene, and tetanus, to an extraordinary degree, consequent,
as it appeared, upon the burial of over twenty thousand
bodies within the limits of the city during the few months
immediately preceding its occupation as a hospital station.

The vicinity of rivers, canals, ponds, marshes, the
mouths of sewers, and other places of the kind, which
ordinarily give rise to malarious emanations, or those due
to the decomposition of organic matter, should likewise be
shunned.

The ground should be elevated in order to secure good
drainage, and also because experience has fully shown that
high situations, other things being equal, are far more
salubrious than those which are low. This circumstance
is due to facts which have already received attention, and
which now admit of application. Elevated points allow of
a freer circulation of air around them, and thus stagnation
is prevented. They are also less exposed to dampness and
malarious influences. Instances, however, are not wanting
in which this consideration has been overlooked. Thus
we are told* that the hospital of the Guards' recruiting
barrack at Croydon is in a low, damp situation, and was
till recently exposed to nuisance from a sewage manure
manufactory, pig-sties, etc., and cases of simple fever re-
ceived into it were found to pass into typhus, or to linger
for months after, to all appearance, they ought to have
recovered. The hospital at Fort Meade in Florida was
situated in the worst possible position, being in a low,
marshy place, exposed to highly concentrated malaria, and
shut off, by a heavy growth of timber, from the rays of the
sun. It was not till its unhealthiness had been thoroughly
ascertained that it was removed. The Hotel-Dieu, in
Paris, which is situated on both banks of the Seine, is un-

* Report of Commission on Barracks and Hospitals, p. 120.

308 A TREATISE ON HYGIENE.

favorably located, as during high water the premises are
overflowed, and an excessive degree of humidity thereby
produced. Many other examples might be brought for-
ward; for, contrary to what should be the case, sites for
hospitals are often selected by persons who have no
knowledge whatever of the first principles of hygiene.

The soil upon which a hospital is to be built should be
of such a character as will not retain moisture; a sub-soil of
clay, for the reasons which have been given, is objection-
able. One of gravel answers all the indications. The
new hospital at Fort Mackinac is built upon the solid rock,
and is consequently not liable to accumulations of water
about it. Too much care cannot be taken to examine into
the character of the soil and sub-soil, for if a site is chosen
regardless of the points laid down, disease — either fevers,
bowel affections, rheumatism, or catarrh — will inevitably be
produced.

The first floor of a hospital should not be placed directly
on the ground. A basement should be under it, or pillars
should be built, raising it three or four feet above the sur-
face. Cellars should not be dug, unless the site is dry and
well drained, as they are otherwise apt to be damp, and
consequently sources of unhealthiness. The long axis of
the building should run north and south, in order that both
sides of it may have the sun on them a part of the day.

In military hospitals it is sometimes impossible to com-
ply with all the necessary hygienic conditions, especially
in those which are attached to permanent fortifications or
barracks. In sea-coast works is this especially the case,
the only available hospital accommodation being the case-
mates. These are notoriously damp, badly ventilated, and
unhealthy. At Fortress Monroe, however, and several
others of the largest fortifications, hospitals have been
constructed apart from the work within the walls, which,
though by no means hygienically perfect, are yet far
preferable to those in casemates.

HOSPITALS. 309

With the general hospitals the case is, however, dif-
ferent, as full liberty is allowed the officers of the medical
department in the selection of the sites for them. We
shall have occasion, in considering particular hospitals, to
allude more particularly to the advantages and disadvant-
ages of their location.

Material for Construction. — For permanent hospitals
stone is preferable to any other material for the walls. It
should be hard and dense, so as to be incapable of absorb-
ing moisture to any extent. Porous stone and brick are
objectionable on account of the facility with which they
absorb water from the atmosphere. If they are used, the
walls should be double, so as to allow of a stratum of air
between them. The experiments of Roscoe,* however,
would appear to show that brick walls allow of the escape
through them of a considerable amount of the carbonic acid
formed within habitations.

For lining the walls Parian cement is to be preferred,
though, on account of its expense, it is often impossible to
provide it. Hard-finished plaster is the best substitute,
but it should be well painted and varnished, to prevent
the absorption of exhalations.

The floors of the wards and offices should be of oak,
saturated with a mixture of beeswax, turpentine, and lin-
seed oil, in order to prevent its absorbing water used in
cleaning, or liquids which may be accidentally spilt.

The floors of the halls and staircases should be of stone
or encaustic tiles.

Temporary hospitals are better constructed of wood than
of other material. When it is practicable, they should be
plastered inside and out and well whitewashed. The
floors should be coated with some water-proof material,

* Quarterly Journal of the Chemical Society of London, vol x. 1858,
p. 251.

310 A TREATISE ON HYGIENE.

such as that before mentioned. They are far healthier
than permanent buildings, an assertion the truth of which
has been thoroughly demonstrated during the present
rebellion. For wounded men tents, both in winter and
summer, are the best of all hospitals.

Form and General Arrangement. — In order to eluci-
date all the points connected with the form and general
arrangement of hospitals, it will be proper to adduce ex-
amples of bad plans as well as of those which are based
upon an acquaintance with sanitary laws. In constructing
and administering a hospital, certain principles are to be
observed.

1st. That it is capable of being well ventilated.
2d. That it is sufficiently capacious for the number of
inmates it is to contain.

3d. That it admits of good drainage.
4th. That it is provided with a sufficient number of
windows.

5th. That the kitchen, laundry, and other offices of ad-
ministration are well arranged and of ample size.

6th. That efficient water-closet, ablution, and bathing
accommodations are provided.

7th. That it is amply supplied with water, and gas or
other means of illumination.

8th. That the furniture, of all kinds, is of suitable
quality.

9th. That the officers and attendants have their proper
respective duties assigned to them, and that they are in
number sufficient for the wants of the sick.

10th. That proper rules are established for the govern-
ment of the hospital, for the diet of the inmates, and for
preserving order and an efficient state of police.

Some of these points will be considered in the course of
the remarks relative to the principles of hospital construc-
tion and to particular hospitals, while others will be more
appropriately discussed under their own separate heads.

HOSPITALS.

311

One of the oldest plans adopted for hospitals, as it is cer-
tainly one of the most objectionable, is that in which three
or four sides of a square are built upon. The disadvant-
ages of it are that both light and air are excluded to a
considerable extent. An example of it is shown in the
accompanying cut, (Fig. 16,) representing the ground-plan

Fig. 16.

GROUND-PLAN OF GUY'S HOSPITAL, LONDON.

of Guy's Hospital, London : a, administration; b, corridor;
c, court-yard; d, principal court-yard; e, entrance;/, walks;
g, wards; h, ophthalmic ward; i, offices, kitchen, etc.
It needs no argument to point out the faults in the con-

312

A TREATISE ON" HYGIENE.

struction of this hospital. The two closed courts effectually
prevent the free circulation of the air, and shut out a large
portion of the light which the patients so imperatively
require.

Fig. 17.

GROUND-PLAN OF THE HOPITAL NECKER, PARIS.

The Necker (Fig. 17) in Paris is equally bad in its
plan, three sides of a square being entirely shut in by
wards, and the fourth partially closed by a gallery: a,
wards; b, chapel; c, kitchen; d, pharmacy; e, offices;/,
officers' rooms ; g, gallery.

The plan under consideration has been entirely aban-
doned for hospitals by all having the slightest acquaint-
ance with the principles which should govern in the
construction of habitations for the sick. It is unfortunate,
therefore, that at Hilton Head, South Carolina, a hospital

HOSPITALS. 313

should have been built, during the first year of the rebel-
lion, combining all the bad features which belong to the
two last described. Fig. 18 represents the arrangement. It

Fig. 18.

GENERAL HOSPITAL, HILTON HEAD, SOUTH CAROLINA.

ToW

SCALE

is essentially a closed court, for the attempt made to open
the sides can lead to very little practical advantage. In
warm climates it is far more essential than in cold or tem-
perate regions that a free circulation of air should be pro-
vided for, and hence the objectionable arrangement of the
hospital at Hilton Head should receive still greater con-
demnation than if it had been built in a northern locality.
It is the only really badly planned hospital which has been

314

A TREATISE ON HYGIENE.

built for the army, though many structures, falling far short
of the requirements of sanitary science, have necessarily
been temporarily occupied by the sick and wounded.

The Bicetre, the Salpetriere, the Saint Louis, and Maison
Municipale de Sante of Paris, and the Ospitale Maggiore
di Milano, are all built upon the general principle of the
closed court or hollow square. The military hospital at
Algiers is designed after the same bad model. With the
exception of the last, these are all old structures.

Another plan, scarcely much better than the closed
court, is that in which the wards are crowded together in
pairs or by fours. The United States marine hospitals, of
the first class, are all constructed upon this model, which
really does not deserve to be considered as one at all
fit for a hospital. The accompanying cut (Fig. 19) repre-

Fig. 19.

MARINE HOSPITAL, ST. LOUIS, (first floor.)

sents the ground-plan of the first floor of the marine hos-
pital at St. Louis. The main wards are indicated by the
letters from c to 7c. The principal object which the archi-
tect appears to have had in view was to prevent more than
one exposure of each ward to the fresh air, doubtless sup-

HOSPITALS.

315

posing that the sailors and boatmen to be admitted would
have had enough of that element before their arrival. In
this undertaking he has met with eminent success, and by
the adoption of the happy idea which suggested itself to
him of putting the square towers at the angles, lie has re-
duced the number of windows in four of the wards on each
floor to one. The others have two each. These wards
are twenty feet square, and are each designed for eight
patients. Each man has therefore but fifty square feet of
surface, and, as the wards are not over twelve feet in
height, he has only six hundred cubic feet of space. The
letters from m to p indicate small wards, intended for two
or three patients. The other rooms are ofhces. The let-
ters a and I refer to the porches. These buildings are de-
signed for one hundred and fifty patients each, are all three
stories in height, and the floors are all arranged upon the
same plan, which is a thoroughly vicious one.

Fig. 20.

]

□

''==

□

- 7 3

CZJ

' '. :T r

□

]

GROUND-PLAN OF THE HOPITAL DE LA CLINIQUE, PARIS.

The Hopital de la Clinique of Paris, (Fig. 20,) which
was originally a monastery, is built upon the same general
plan as the marine hospitals just described.

Most of the old post hospitals of the army are con-
structed after a similar model, though they are so arranged
that two sides of each ward are exposed to the external

316

A TREATISE ON HYGIENE.

air. A plan of the principal floor is shown in Fig. 21 :
a, hall; h b, wards; c c, water-closets. A veranda surrounds

Fig. 21.

UNITED STATES ARMY POST HOSPITAL.
SCALE T ^ 2 .

the building. The chief objections to these hospitals are,
deficient ventilation and want of capacity. They do not
admit of more than five hundred cubic feet of space being
allowed to each patient when the ordinary proportion of
the men composing the garrison is sick.

In 1860 new plans were adopted for the construction of
quarters, barracks, and hospitals, which, though improve-
ments on the old ones, are not, so far at least as the
hospitals are concerned, such as sound sanitary science
would dictate. It is not probable that they will be carried
out, and therefore it is scarcely worth while to discuss
them.

HOSPITALS.

317

Fig. 22.

"73

_mrn

"T3±£i

318 A TREATISE ON HYGIENE.

Another objectionable plan, and one which has been ex-
tensively used, more or less modified, according to the
whim or caprice of the designers, is that in which the
wards are arranged on one or both sides of a close corridor.
The hospitals at Rotterdam, Hamburg, and Bremen are
built after this plan. The wards are small and badly
ventilated.

The new military hospital at Netley is also constructed
after this principle. It was built by the engineer corps of
the British army without, as I understand, the advice of
the medical department being asked in the matter. As it
is the most extensive military hospital in Great Britain,
and has cost a large sum of money, it is unfortunate that a
better design was not selected. The wards are of small
size, containing each from nine to fourteen beds, and gen-
erally have but one face exposed to the external air. The
ventilation and lighting are not therefore such as they
should be, and from the small size of the wards it is diffi-
cult and expensive of administration. Fig. 22 is a repre-
sentation of the ground-plan of the main floor of this hos-
pital.

Several of the civil hospitals of this country are built
according to the plan last referred to. None of the mili-
tary hospitals which have been constructed during the
present rebellion have, however, ' been thus arranged,
though it has been found necessary to occupy buildings
for hospital purposes the rooms of which are placed on one
or both sides of a passage way. The Seminary Hospital
in Georgetown (Fig. 23) is one of this kind. Originally
constructed for a school, it was found necessary to occupy
it as a military hospital. A closed corridor a runs nearly
the whole length of the building, and the wards d are
placed on one side of it. The opposite end of these wards
faces the street. One large ward e is better situated; b is
a bath-room, and c a veranda. The first and third floors

HOSPITALS.

319

are similarly arranged. The basement contains the kitchen
and other offices.

Fig. 22.

SECOND FLOOR SEMINARY HOSPITAL, GEORGETOWN.

The whole plan of this building is such as renders it not
a very desirable one for use as a hospital. It had at one
time over three hundred beds, but since it has been occu-
pied as an officers' hospital the number has been materially
reduced.

Fig. 24.

SECOND FLOOR GOOD SAMARITAN HOSPITAL, ST. LOUIS.

The Good Samaritan Hospital in St. Louis is another
example of this form of construction. The cut (Fig. 24)
represents a plan of the second floor. In this institution

320

A TREATISE ON HYGIENE.

the wards c to i are arranged on both sides of a corridor
a; h indicates the bath-room, I the water-closet, and in a
veranda. Two other floors are similarly planned. In
addition, there is an attic, with a somewhat different but
no better arrangement.

There are many other instances of bad hospital plans
which do not come under any specific heading, but which
are sufficiently objectionable to warrant attention, in order
that their defects may be pointed out and avoided.

In the new hospital of King's College, London, the wards
are double, an arrangement which is objectionable on ac-
count of the difficulty of isolating any patient from the
effluvia given off by the others. The accompanying cut
(Fig. 25) is a plan of this hospital: a, the chapel; b, the

Fig. 25.

tltU

GROUND-PLAN OF KING'S COLLEGE HOSPITAL, LONDON.

amphitheater ; c, wards ; d, reception rooms ; e, office. It
is thus seen that in the principal rooms intended for the
reception of the sick there are four rows of beds between
the windows, and consequently the exhalations from three
of the rows of beds pass over the other row before they can
escape from the ward by the windows. The whole plan is

322 A TREATISE ON HYGIENE.

also most bunglingly conceived. The windows are on one
side only of the wards, and the corridors, chapel, and am-
phitheater are so placed as effectually to close the courts,
and thus some of the wards are entirely shut *off from a
free circulation of air about them. It would be difficult to
meet with a worse constructed hospital in any country
than that of King's College. The new wards of Guy's
Hospital are arranged upon the same general plan as those
just described.

Hospital wards should never contain more than two
rows of beds. In military hospitals, from the sudden
necessities of the service, large numbers of sick and
wounded are thrown upon the hospitals, and of course
must be provided for. It then occasionally becomes neces-
sary to put an additional row of beds along the center of
the wards, but they should be removed as soon as possible,
no matter what may be the width of the room.

The military hospital at Arbour Hill, Ireland, exhibits
another peculiarly bad style of arrangement. As is seen
from the cut (Fig. 26) it is divided into four sections, each
of which is complete in itself, having its own ward, sur-
gery, kitchen, store-room, etc. Aside from the expense
and inconvenience of such a plan, it takes up room for un-
essential objects, which might have been devoted to the
reception of patients. I do not know that there is a hos-
pital in the United States constructed on such an absurd
principle as is the one at Arbour Hill. It is very properly
condemned by the commission which examined it and the
other military hospitals of Great Britain and Ireland.*

Another faulty plan is that in which several stories are
built, one over the other. It may be laid down as a rule
that hospitals should never consist of more than two floors
of wards; one is preferable, owing to the great difficulty of

* Report, p. 128.

HOSPITALS. 323

administration more than counterbalancing any advant-
ages that may be derived from the other arrangement.
It is true, as we have seen, that the upper rooms in build-
ings are more healthy than the lower, but the advantages
of elevation can be secured by a high basement range,
which should be constructed for storage and other pur-
poses of the kind.

This plan of three or more floors is a very common one in
hospitals in cities where ground is scarce, especially in those
which were built several years since; but even the new
hospitals Lariboisiere and the military one at Vincennes
have three tiers of wards, a very decidedly objectionable
feature in their otherwise generally excellent arrangement.
The City and Bellevue Hospitals of New York have also
three stories of wards.

But, in addition to the difficulty of administration, there
is another objection of even still greater weight. The
crowding together of so many wards under one roof has
the same effect as placing too many sick in one room. It
has been definitely determined that not more than one
hundred sick can be kept under one roof without an in-
creased mortality being the result. And it does not make
a great deal of difference whether they are contained in
one sufficiently large room or in several smaller ones.

Other objectionable principles of hospital construction
will be pointed out in the descriptions of those hospitals
which are built upon generally good plans, but which pos-
sess some features in their arrangements which do not
admit of commendation.

324 A TREATISE ON HYGIENE.

CHAPTER XIV.

PRINCIPLES OF HOSPITAL CONSTRUCTION.

In setting out to build a hospital, the first object to be
had in view is the provision of ward accommodation; the
next the provision of accessories, such as kitchens, water-
closets, bath-rooms, offices, etc. We shall therefore first
consider the best form for the ward, and the several
appointments which should be given to it.

"Wards. — A hospital ward should be of an oblong shape,
the form which is best adapted for the arrangement of
beds, and supplying the patients with sufficient light and
fresh air without wasting space. The width should not
exceed twenty-five feet, a space which will allow seven
feet six inches for the length of each bed, with a passage
of ten feet between the rows. If the width is greater than
this, the distance between the windows is such as to pre-
vent free ventilation ; if less, sufficient room is not afforded.

In permanent hospitals the height should not be less
than fourteen feet, nor over sixteen. Less than this ren-
ders the air close, while more is of little or no advantage.
In temporary hospitals, such as those often required in the
army during war, which are not ceiled, and which are
ventilated at the ridge, twelve feet to the eaves will be
found to answer if the roof is high pitched — the only kind
which should be constructed, as flat roofs are more liable
to leakage, and render a ward hotter in summer than those
that are steep.

The length of the ward depends upon the number of
beds it is to contain. The bed should be about three feet

PRINCIPLES OF HOSPITAL CONSTRUCTION". 325

in width, and the average distance between should be four
feet. As they are arranged in pairs between the windows,
the two beds of any one pair are not so far from each other
as this; but compensation should be made by increasing
the distance between the pairs, so that it may average about
four feet. Each bed therefore occupies a space in the
length of the ward of seven feet, consequently a ward in-
tended for fifty beds — twenty-five on a side — would be
25 x 7 = 175 feet, the length of the ward. A ward
therefore of these dimensions (25 x 175 x 14) contains
60,250 cubic feet, or 1205 cubic feet to each of the fifty
patients.

These dimensions are the very lowest which should ex-
ist in the wards of permanent hospitals in any part of the
United States. Every patient in such institutions should
receive, as a minimum allowance, 1200 cubic feet of space,
about 87 of which should be superficial. If less than this
is allotted to him, an offense is committed against the laws
of human health, which can only be excused on the ground
of absolute necessity.

In temporary hospitals, ventilated at the ridge and fur-
nished with a sufficient number of windows, less than this
will suffice, provided they are built after the plans which
have been shown to be most advantageous to the sick and
wounded who are to inhabit them; and consequently in
such wards the length need not be so great as in those of
permanently built hospitals. In these ridge ventilated
wards, of the same width as the others and the same
average height, the mean distance between the beds need
not be more than two and a half feet; 25 x 5 J = 137 h
feet, the length of a ward intended for fifty patients. Such
a sized ward contains 48,125 cubic feet, which is about 960
to each patient.

This is the basis upon which all temporary hospitals
should be constructed, and although, from the necessities

326 A TREATISE ON HYGIENE.

of the service, it may often be impossible to give to each
inmate as much space as the requirements of sanitary
science demand, he should receive it without fail as soon
as the exigency, which has caused a reduction in his
allowance of space, has ceased to exist.

The width of twenty-five feet has been given as a stand-
ard. The bedsteads should be six feet three inches in
length, and should stand nine inches from the wall. This
gives seven feet for the length of the bed and fourteen for
the two rows, leaving therefore a passage down the center
of the ward of eleven feet in width. This space is neces-
sary not only as a hygienic measure, but as room re-
quired for tables, chairs, and other ward furniture. The
width of the ward is therefore invariable, and is the basis
from which the other measurements are to be determined.

As has been said, the mean height of a ward should not
be less than fourteen feet, and it is upon this, as a stand-
ard, that the cubic space per patient is to be apportioned.
It will not answer to make the wards high and to curtail
them proportionally in the other dimensions, for after the
height of fourteen or fifteen feet is attained in a ward the
air of any space above that is of very little practical benefit
to the patient. It is by no means impossible to produce
sickness in well persons by crowding them together in the
open air, where the number of cubic feet of air to each is
only limited by the height of the atmosphere above the
surface of the earth. The number of square feet to a
patient, in a ward fourteen feet high, should not, in perma-
nent hospitals, be less than eighty-five, nor in temporary,
ridge ventilated wards, less than sixty-five feet.

The windows in a ward should be of ample size, cer-
tainly not less than five feet in height. The number
should be determined by the size and capacity of the ward,
one being allowed for every two patients. They should
be placed in the long sides of the ward.

PRINCIPLES OF HOSPITAL CONSTRUCTION. 327

Two beds should be placed between every two windows,
the heads standing toward the walls, but distant about
nine inches from them. The arrangement of the beds and
windows, as well as the proportions of the ward, are shown
in the accompanying cut, (Fig. 27,) in horizontal and ver-
tical sections. The plans represent a ward for twenty-six
beds. Wards of double the length are usually those which
are found in the new military hospitals built since the com-
mencement of the present rebellion. Such wards contain
fifty-two beds, a number which should not be exceeded.

Fig. 27.

pDDDDDDMDDDl ^_^

Now in addition to the ward, and constituting almost a
part of it, as they are connected with it directly, are certain
rooms which are indispensable. These are a bath and
ablution room, a water-closet, and a ward-master's room.
Besides, a mess-room is often added, in which those pa-
tients who are able to leave their beds eat their meals,
and in which a sink is placed for the convenience of wash-
ing dishes. When the mess-room is not attached to the
ward, a scullery takes its place. Occasionally a small
extra diet kitchen is one of the offices.

The ward-master's room is a very necessary appendage,
and generally has a window opening from it into the ward,
in order to allow a proper supervision to be exercised over
the inmates by the ward-master. The bath and ablution
room and water-closet are at the same end, the latter
being farthest from the ward. In all military hospitals,
so situated that water can be supplied from a main, an
abundant supply is thus obtained, both hot and cold.

328 A TREATISE ON HYGIENE.

One bath-tub will be found sufficient for every twenty-six
patients; one basin and one latrine for every ten. The
basins should be placed in a trough lined with zinc, over
which the water-taps are to be fixed. In permanent hos-
pitals earthenware basins, set in marble, are to be pre-
ferred. The bath-tubs may be of iron enameled, slate, or
wood lined with zinc. One window will be sufficient for
this room.

The water-closet should be well ventilated by one of the
methods to be hereafter described. The form of latrines
to be used is to be determined by circumstances. If water
is supplied, any one of the numerous patterns in use which
carry the fecal matter at once from the premises will
answer. A form used in many of the military hospitals,
especially by those in Philadelphia, which consists of a
large iron trough, capable of being flooded, and over which
the holes are placed, is not suited for hospitals. It always
has a bad odor about it, no matter how carefully it is at-
tended to. When water is not introduced into the build-
ing, boxes or tubs are to be so placed as to receive the
evacuations. These must be scrupulously emptied every
morning.

Fig. 28.

GROUND-PLAN OF WARD FOR TWENTY BEDS.

In the accompanying cut (Fig. 28) the arrangement
of the ward and offices, as recommended by the Com-

PRINCIPLES OF HOSPITAL CONSTRUCTION. 329

mission to which reference has so often been made, is
represented: a is the ward, b the attendants' room, c
scullery, d water-closet and sink, e bath-room and ablu-
tion table, / ventilated lobbies. This plan is a very excel-
lent one, and scarcely admits of improvement. Others will
be given which have been adopted in the large military
hospitals erected by the United States during the past
year.

The unit of the hospital has now been briefly described.
In the next place attention must be called to the various
administrative offices which are rendered necessary by the
aggregation of several such wards, or by one alone when
the hospital is small, to the most approved plans of ar-
ranging the wards with reference to each other and to
the other buildings which are necessary to a large hospital.

Administrative Department. — In describing the ward,
the offices which are for the immediate use of the inmates
have also been considered. Others, however, are neces-
sary for the transaction of the business of the hospital, and
for providing for those wants of the patients which they
cannot supply for themselves. The rooms thus required
in a military hospital are —

1. Surgery.

2. Hospital office and chief medical officer's office.

3. Store-rooms.

4. Medical officer's quarters.

5. Hospital steward's quarters.

6. Apothecaries and nurses' quarters.

7. Kitchen and appurtenances.

8. Laundry.

9. Dead-house.

The size of these rooms will of course depend very much
upon the size of the hospital, and the arrangement of them
may well be left to the individual preferences of the chief

330 A TREATISE ON HYGIENE.

medical officer, certain general principles being kept in
view. Thus the office in which the records are kept, and
in which the business of the hospital is conducted, should
be easy of access to visitors, and at the same time so
situated as to be out of the way of the patients. The
surgery should be under the special control of the chief
steward, who should himself be a skillful apothecary.
Store-rooms should be for three descriptions of articles:
for medical supplies, for linen and bedding, and for provi-
sions. Kooms intended as quarters for the officers and
attendants should be of ample size and completely fitted
up. The officers' rooms should contain at least 225 square
feet each, and only one person should occupy each room.
Those for the attendants should be of such a size that
each occupant should have at least 60 square feet.

The kitchen should be entirely detached from the hos-
pital, or should occupy a part of the building away from
the wards. It should be fitted up with ranges and caul-
drons as permanent fixtures, and if possible should be
supplied with water from a main.

A mess-room should be connected with the kitchen for
the convalescents and attendants, and sculleries and pan-
tries should also be attached to it.

The laundry is an important part of the hospital. It
should be a separate building from the establishment, or
placed in a remote part of it. Cauldrons supplied with
water, which can be heated by steam, washing tubs, iron-
ing machines, etc. should be furnished.

The dead-house should be sufficiently remote from the
hospital, should be well ventilated and lighted, and fur-
nished with the necessary means for conducting post-
mortem examinations.

General Plan of the Hospital. — In building a hospital,
the principle is not to be lost sight of that the sick are to
be entirely separated from the administrative part of the

PRINCIPLES OF HOSPITAL CONSTRUCTION.

331

building. In fact, they are to have a separate house for
themselves. A collection of such buildings constitutes the
hospital, which, therefore, has a not indistinct resemblance
to a polyp. Reduced to its simplest form, a hospital con-
sists of two parts — the ward and the administration. In
the figure, (29,) a is the ward, b is the administration.

Fig. 29.

The latter is a constant factor, the other a variable one;
there may be many wards, but there is only one adminis-
tration.

In the next figure (30) a slight amplification is made.
There are two wards, a a; and a detached kitchen, c, has
been added to the administration.

Fig. 30.

□

The principle therefore is that the wards form a collec-
tion of hospital buildings which center around a nucleus —
the administrative department. No other arrangement
than that which entirely separates the wards from each
other is worthy of consideration, except to receive con-
demnation. Any other is altogether unfit to meet the
necessities of the sick, and affords conclusive evidence
that the designer is ignorant of the first requirements of
sanitary science. This plan consists in having separate

332 A TREATISE ON HYGIENE.

pavilions, built after the model of that already described,
and arranged in such a manner as to admit of convenient
administration without sacrificing anything essential to the
health or comfort of the patients. There are many ways
of effecting these objects; and it will be advisable to bring
under notice some of the most approved plans of hospi-
tals both in Europe and this country. Among the latter
several of the immense structures rendered necessary by
the exigencies of the military service of the country, and
surpassing in magnitude any hospitals that the world has
ever seen, will receive special consideration. In this way
it is hoped the student will obtain instruction in the im-
portant matters of hospital construction and administra-
tion, which will prove both interesting and important to
him.

A perfect hospital has never yet been built, and perhaps
never will be. It seems to be almost impossible for those
having charge of hospital construction to obtain all the
means which they deem necessary to insure perfection, and
it sometimes happens that when the most ample resources
are placed at their command, the hospital falls far short,
architecturally and hygienically, of what might have been
accomplished. In the descriptions which follow I shall
point out not only the meritorious features, but also those
characteristics which I consider to be defects.

Among the hospitals of Europe which are regarded as
best fulfilling the requirements of hygiene, the Lariboisiere,
at Paris, is especially to be noted. As long ago as 1786
a commission of the Academy of Sciences, appointed to de-
termine upon the best plan to be followed in rebuilding
the Hotel-Dieu, which had been destroyed by fire, reported
in commendation of the system of having separate pavilions
constructed. The report was not acted on favorably, but
several years afterward the recommendations made were
carried out, and the Lariboisiere Hospital is the result.

PRINCIPLES OF HOSPITAL CONSTRUCTION.

333

The arrangement of the pavilions and of the several ad-
ministrative apartments is seen in the accompanying cut,
(Fig. 31,) representing a ground-plan of the hospital : a a,

Fig. 31.

LARIBOISIERE HOSPITAL— GROUND-PLAN.

wards ; h b, open ground. The pavilions, of which there
are six, are each three stories high. Each floor contains
two wards, one for thirty-two beds and one small one for
two beds. There are thus one hundred and two beds in
each pavilion. The large wards are 111 feet long and 30
feet wide. There are thus 3330 square feet of surface,
equivalent to a little over 104 square feet to each bed.
The wards on the first floor are 17 feet 6 inches high, on
the second floor 16 feet 8 inches, and on the third 16 feet
4 inches. The cubic space to each bed is thus on the first
floor 1860, on the second 1740, and on the third 1700 feet.

334 A TREATISE ON HYGIENE.

The details of the construction of a flat are seen in the
accompanying plan, (Fig. 32:) a, the library; b, visitors'

Fig. 32.

DETAILS OF WARD— LARIBOISIERE.

room; c, exercise grounds; d, discharging shaft; e, stair-
case; /, corridor; g, latrines; 7i, office; k, mess-room; Z,
large ward; m, small ward. The windows are sixteen in
number, eight on a side; each is 4 feet 8 inches wide, and
extends nearly to the ceiling. Each pavilion is 55 feet
high, and the distance between them is 64 feet. An open
corridor runs entirely around the whole structure, connect-
ing the pavilions to each other and to the administrative
departments. There is a free circulation of air therefore
from one side to the other. The mess-rooms are eight in
number, and are but one story high.

The administrative offices of the building are repre-
sented, in the ground-plan of the hospital, by the light
shaded parts.

Although the Lariboisiere is a vast improvement on the
great majority of hospital plans, it has several serious
faults. In the first place, the pavilions have too many
stones— one, or at most two are to be preferred. The
wards are consequently too much crowded together, and
there cannot be the same facility for conducting the ad-

PRINCIPLES OF HOSPITAL CONSTRUCTION. 335

ministrative departments as in hospitals of a less num-
ber of floors. Much time is lost and fatigue incurred to
the officers and attendants in having so many flights of
stairs to mount and descend. Moreover, the third floor
of a building is not so healthy as the lower ones. The
second is the healthiest, the first next, and the third least
of all.

Another objection is found in the fact that the pavilions
are too close together, so much so that in the morning and
toward sunset the lower floors are shut off from the direct
rays of the sun. The distance between the pavilions
should be at least double the height, in order to allow of
the free circulation of air, diminish the injurious results of
bringing many sick and wounded together, and admit of
each ward receiving direct sunlight at some time of the
day.

In the new military hospital at Vincennes a different
manner of arranging the pavilions has been adopted, which
allows of still greater advantages as regards the circulation
of air and light. In the accompanying cut (Fig. 33)
a ground-plan of this institution is given : a, offices, guard-
room, chapel, and other administrative apartments; b,
kitchen, linen-room, and accommodation for 18 sisters and
308 soldiers; c, pharmacy, baths, and accommodation for
21 officers and 308 soldiers.

The ward pavilions are each 340 feet long, and have
three stories and an attic. The wards are of different
sizes; the larger ones are 135 J feet in length by 26 feet 4
inches in width. They contain each 40 beds, and there
are consequently about 90 superficial feet to each bed.
The wards on the first floor are 15 feet high, and those of
the second and third 13 feet 7 inches. The attic wards
are not ordinarily occupied. In the wards on the lower
floor the allowance of space is 1334 cubic feet per bed, on
the wards of the upper floors it is 1200 cubic feet. The

336

A TREATISE ON HYGIENE.

windows are 5 feet 2 inches wide and 9 feet 2 inches high.
The proportion of windows to beds is the same as in the
Lariboisiere.

Fig. 33.

GRASS PLAT

CO R R I DOR

H H

MILITARY HOSPITAL AT VINCENNES— GROUND-PLAN.

The military hospital at Vincennes was commenced in
April, 1856, and opened for the reception of patients June
1st, 1858. It has accommodations for six hundred and
sixty-five sick — twenty-one officers and six hundred and
forty-four soldiers. A barrack intended for the accommo-
dation of the nurses is not yet constructed. The entire cost
of this hospital is 2,479,000 francs, or about 500,000 dollars.

PRINCIPLES OF HOSPITAL CONSTRUCTION.

337

The objectionable features of the Vincennes hospital are
that it has too many stories, and that to pass from one
pavilion to another there is but one way. In other re-
spects it is very well arranged.

^ n n n n , jj

uu uu

The Blackburn Hospital, near Manchester, England, is
very well planned, but the wards are too small for eco-
nomical and convenient administration. The accompany-
ing cut, (Fig. 34,) from the admirable work of M. Hus-

338 A TREATISE ON HYGIENE.

son,* represents the plan of the first floor: a, operating the-
ater ; b, wards for the reception of patients operated upon ;
c, wards; d, wards for special cases; e, mess-rooms; /, read-
ing-rooms; g, corridor; h, balcony; i, discharging shaft, by
which soiled linen, dressings, etc. are passed to the base-
ment; k, bath-rooms; I, latrines; m, sitting-rooms and rooms
for officers; n, kitchen for officers; o, rooms for officers;
p, bed-rooms for nurses.

The larger wards in the hospital are 39 feet long, 23 feet
wide, and 16 feet high. As there are but eight beds in
each of these wards, the allowance of cubic feet of space for
each is 1794 feet. Each ward has 10 windows, 3 feet wide
and 9 feet high. They extend from 2 feet 7 inches above
the floor to 4 feet 9 inches from the ceiling. In this last
interval ventilating openings, covered with plates of per-
forated zinc, are made.

The floors of the wards are of Norway pine, and are
soaked with a water-proof material. The walls and ceil-
ings are coated with Parian cement.

The kitchens for the patients are in the basement, and
the food and fuel are raised by means of dumb-waiters.

Up to the present time the cost of the Blackburn Hos-
pital has been, including the ground, 85,000 dollars, and it
is estimated that an additional sum of 34,000 dollars will
be required to finish it. It will contain about 140 patients.

It is to be regretted that the wards of this hospital were
not so far extended as to admit of their accommodating
thirty-two or forty-eight patients each, which could have
been done with but comparatively small additional ex-
pense. As it is, the Blackburn Hospital must be regarded
as one of the most admirably arranged in Great Britain.
As will be seen hereafter, two of the military hospitals of
the United States are constructed upon a somewhat similar
plan.

* Etude sur les Hopitaux. Paris, 1862.

PRINCIPLES OF HOSPITAL CONSTRUCTION.

339

The hospital of Saint Louis, at Turin, is somewhat
unique in its arrangements, and possesses some features in
its construction worthy of consideration by those who have
the designing of hospitals committed to them. M. Gaul tier
de Claubry* calls attention to it, and M. Armand Hussonf
cites its plan as deserving of imitation in some particulars.
I can bear testimony to its excellent management, and to
the facility with which it is administered. As will be ob-
served from the accompanying plan, (Fig. 35,) which rep-
resents the ground-plan of the first floor, the pavilions are
arranged so as to form a figure resembling the letter X.

Fig. 35.

ST. LOUIS HOSPITAL, AT TURIN.

In the plan a is the vestibule; b, reception-room; c, princi-
pal staircase; d, chapel; e, wards; /, passage behind the beds;
<7, offices of various kinds; h, latrines. The passage behind
the beds serves for the removal of any patient from the
ward who has died, or who is to be operated upon, with-
out the other patients having the matter brought to their
attention. Behind each bed is a door communicating with

* Annates d'Hygiene, 1859, tome xi. p. 118.
f Op. cit, p. 471.

340 A TREATISE ON H7GIENE.

the passage through which the bed is taken, curtains having
in the mean time been drawn around it.

The principal objection to be urged against the Saint
Louis Hospital is the fact that the windows do not open
directly from the wards to the external air, and that the
courts are not sufficiently open to the free circulation of
the atmosphere.

The chief advantageous feature is the slight distance
. that the wards are placed above the ground, by reason of
which circumstance the convalescents are enabled to take
a moderate amount of exercise without being obliged to de-
scend and ascend long flights of steps, than which nothing
is more fatiguing.

Among the German hospitals, the Charite* and Bethaney
at Berlin, the Allgemeines Krankenhaus and Wiedner
Krankenhaus at Vienna, and the Hospital zum Heiligen
Geist at Frankfort, though not so perfect in their con-
struction as those specially referred to, have some good
points about them. As a rule, however, the German hos-
pitals are not to be compared to the French so far as hy-
gienic considerations go. Most of them are either rectan-
gular structures or else are so arranged that the wards
open on close corridors, like those at Hamburg, Bremen,
Rotterdam, and Zurich, already cited.

Among the proposed hospitals, those to be built at
Woolwich and Malta, if constructed according to the
plans which have been approved, will be very admirable
structures.

The ground-plan of the first floor of the Woolwich Hos-
pital is shown in the cut, (Fig. 36.) The detached build-
ing contains the administrative offices, and is three stories
high, besides the basement. The pavilions are arranged
m pairs, opening on a corridor at right angles to its length.
At the distant end of each ward are the lavatory and bath-
room, and water-closet, at the other extremity the scullery

PRINCIPLES OF HOSPITAL CONSTRUCTION.

341

and nurses' room. Seven of the wards on this floor are for
thirty-two beds each, and three for twenty-eight beds. At

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one end -of the corridor are ,a number of small wards for
lunatics, and at the other the operating ward and operating

342

A TREATISE ON HYGIENE.

theater. The pavilions are two stories high, exclusive of
the basement. There is no objection of any consequence
to offer to the general arrangement of this building, which

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will, when completed, be a model military hospital. It will
contain six hundred and fifty beds.

The proposed military hospital at Malta, (Fig. 37,) though

PRINCIPLES OF HOSPITAL CONSTRUCTION. 343

not so complete in its arrangements as the one at Woolwich,
possesses certain advantages over that hospital. Being built
in a bastion of the fortification, it was necessary to make
the pavilions of different sizes, in order to lose no ground.
This, however, allows of the freer access of air to the
wards. The pavilions are two stories high, and contain
each two wards. The water-closets and bath-rooms are at
the far extremity of the wards, and the nurses' rooms and
sculleries at the end joining the corridor. The administra-
tive building is in front, and is connected with the main
corridor by passage-ways, two courts intervening. Each
bed has about 96 superficial feet and 1540 cubic feet of
space.

In the next place, we come to the consideration of the
hospitals of the United States ; and we shall find that in
hygienic requirements they are, with few exceptions, fully
equal to the best which have been erected in Europe. The
Pennsylvania Hospital at Philadelphia is built upon a plan
very similar in its general features to the plan recently
adopted by the British Government for its regimental hos-
pitals. It consists of a central administrative building,
with pavilions extending from two of its opposite sides.
These pavilions are two stories high, exclusive of base-
ment. The allowance of space to each is somewhat over
1700 cubic feet. There are detached buildings which are
devoted to syphilitic and labor cases.

There are only two of the many large and admirable
civil hospitals of the United States to which we design
drawing special attention, and these are the Free City
Hospital of Boston and the Episcopal Hospital of Phila-
delphia. In some respects these hospitals are superior to
any which have been constructed in any part of the world,
and so far as can be perceived fulfil all the requirements
of sanitary science.

344

A TREATISE ON HYGIENE.

The accompanying cuts (Figs. 38 and 39) exhibit a per-
spective view and a ground-plan of the principal floor of
the Free City Hospital, now being erected in the City of

Fig. 38.

BOSTON FREE HOSPITAL— ELEVATION.

Boston, and which was designed by Henry G. Clark, M.D.,
one of the surgeons of the Massachusetts General Hospital.

.Fig. 39.

BOSTON FREE HOSPITAL— GROUND-PLAN.

The particular style chosen is the modern style of Re-
naissance architecture, a style which, from its own inherent

PRINCIPLES OF HOSPITAL CONSTRUCTION. 345

beauties, not less than from its almost universal suscepti-
bility of adaptation to structures of a dignified and monu-
mental character, stands confessedly at the head of all the
forms of modern secular architecture in the chief capitals
of the world.

In this case, while all the most essential sanitary condi-
tions have been well considered and secured, the designer
has not failed to avail himself of so rare an opportunity for
architectural effect. The very necessities of the plan, as
described above, are of themselves the sources of some of
the highest architectural beauties. A central building,
with a portico surmounted by a bold and picturesque
dome, and connected laterally by means of open colon-
nades, with advanced pavilions of a corresponding style of
architecture, presents in its own absolute requisitions the
groundwork for artistic effect of the highest order, and
such as in buildings intended for other and different pur-
poses, great additional outlay and serious inconveniences
of arrangement have sometimes been submitted to in order
to attain. The primary and secondary masses of light and
shade in the composition are, by this arrangement, made
to glide into each other by the most gradual transitions of
effect, while the open screens of double columns in the cor-
ridors curve round into different relations of position and
shadow with each footstep of the advancing spectator.

The design embraces six separate pavilions radiating
from a central structure, but entirely disconnected with
this building excepting by corridors or walks, each of the
quadrant of a circle in form. The pavilions are intended
to be so grouped with reference to the central building as
to be located in parallel rows of two pavilions each, on
three sides of the central building, at the distance of
eighty feet therefrom. The ends of the pairs of pavilions
face three of the four streets which surround the site, and
are located one hundred feet back from the margin of the

346 A TREATISE ON HTGIENE.

site or side of the street against which they face. The
principal facade of the plan, which comprises two of the
pavilions and the central building, is designed to be located
one hundred feet from the margin of the site, while the
center building itself is removed to a distance of one hun-
dred aftd forty feet from the street.

The four larger pavilions of the six will accommodate at
least 50 patients each, and are 117 feet in length and 28
in width. The remaining two pavilions are intended for
25 beds each, and measure 89 feet in length and 28 feet in
width. All of them are of two finished stories in height,
with a basement story, which is connected, by a little
tramway through the corridors, with the central building
and all the other pavilions. The central building is 60
feet square and three stories in height, and is intended
exclusively for the officers' apartments, offices, kitchens,
theater, and other apartments requisite for the administra-
tion and supervision of the whole institution.

The pavilions are so located as to be one hundred feet
apart in the clear, and at an average distance of one hun-
dred feet from the central building, thus securing the most
ample space for light and ventilation to and between the
several buildings composing the complete design. By this
arrangement and position any one of them, as they each
have separate kitchens, etc., may be made a complete and
independent hospital of itself, so that the plan may be
extended at any future time, as circumstances may re-
quire.

In this hospital every precaution seems to have been
taken to secure the hygienic advantages which such institu-
tions should possess. The larger wards are 100 feet in
length and 28 in width, the remaining 17 feet of the
length of the pavilions being appropriated to the water-
closet, bath-rooms, and nurses' room. Each patient will
therefore have over 100 square feet of surface and about

PRINCIPLES OF HOSPITAL CONSTRUCTION. 347

1600 cubic feet of space. The windows are large and
numerous. There being but two floors of wards, there are
consequently but 50 patients under one roof.

In the smaller wards the superficial area and cubic space
allowed to each patient are still greater. These wards are
for such cases as require the most ample allowance of
room.

The dead-house is conveniently placed in the rear imme-
diately opposite the center of the administrative building.

In extending this hospital — should such a procedure be-
come necessary — it can readily be done by prolonging the
two anterior corridors, so as to continue them in parallel
lines, and building pavilions from them corresponding to
the others, and also by following a similar plan with the
two corridors from which the small pavilions are extended.
The present plan is intended for 250 patients, with the
necessary number of officers and attendants.

It is not to be denied that a system such as that upon
which the Boston Free Hospital is constructed is much
more expensive than when the wards are huddled to-
gether, and party-walls and few windows are the result.
So far, however, as the interests of the inmates are con-
cerned — and if they cannot be made paramount to every
other consideration, hospitals had better not be built —
there can be no doubt of its advantages.

For a military hospital, the plan in question would answer
admirably, slight alteration in the administrative building
only being required.

The Episcopal Hospital of Philadelphia is situated on
the outskirts of the city, in a locality which is removed
from any endemic sources of disease. In architectural
finish and in completeness of detail, in all that regards the
comfort and hygienic condition of the patients, this hos-
pital is not excelled by any other in the world. It con-
sists of a central building, containing a chapel, operating

348 A TREATISE ON HYGIENE.

theater, etc., from which a corridor proceeds on each side.

Fig. 40.

—

111 ,1 ;;',: ,;li
I'll' III ' ■<<■' ■

GROUND-PLAN OF EPISCOPAL HOSPITAL, PHILADELPHIA.

From this corridor the pavilions are built at right angles.
The material is a dark sandstone. The halls, floors, and

PRINCIPLES OF HOSPITAL CONSTRUCTION. 349

stairs are of stone, and the floors of the wards of yellow pine,
saturated with a varnish impermeable to water. There are
two floors of wards, besides an attic for special cases, in
each pavilion. In addition, there are basements, in which
are the kitchens, store-rooms, etc., connected with each
other by means of a subterranean passage, through which
a railway passes. Fig. 40 represents the ground-plan of
the first floor: a a, corridor; b b, veranda; c c, ward
pavilions; d, chapel; e e, small rooms for private patients.

The main wards are 30 feet 10 inches wide by 120 feet
long. There are seven windows on one side and eight on
the other, besides two in one end. These wards contain 30
beds; each patient has therefore over 120 square feet of sur-
face, and as the wards are 16 feet high, there is an allowance
per patient of 2000 cubic feet of space. The water-closets
and bath-rooms are at each end of the ward and outside of
it. A nurses' room, scullery, dining-room, library, and day-
room, besides several closets, are attached to the ward.
The details of a ward pavilion are given in Fig. 41 :
a, ward ; b b, water-closets ; c c, bath-rooms ; d, nurses'
room; e, scullery; /, dining-room; g, ward-library and
day-room ; h, clothes-room ; i, dumb-waiter ; k, corridor ;
I 1, closets.

The open spaces seen in the walls represent sections of
the ventilating flues. These flues all converge to a large
chamber under the eaves of each ward, which opens by a
shaft to the external air, and which is heated by steam
contained in a coil of iron pipe. Fresh air is admitted by
other flues at the ends of the wards, and is heated by steam
before its entrance.

The operating theater is in the central pavilion on the
upper floor. The capacity of the hospital is fixed at 325
beds, including those for private patients in the small
rooms of the central pavilion.

The permanent military hospitals of the United States

350

A TREATISE ON HYGIENE.

are, as we have said, of little importance as models. None
of them are built after the plans which have been adopted

Fig. 41.

DETAILS OF WARD PAVILION, EPISCOPAL HOSPITAL

by hygieists as best coming up to the standard required by
sanitary science. In Fig. 42 the elevation and ground-

PRINCIPLES OF HOSPITAL CONSTRUCTION.

351

Fig

. 42.

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1 j i

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352

A TREATISE ON HYGIENE.

plan in outline of a permanent hospital, which it is pro-
posed to erect at Fort Delaware for the garrison of that
post, are shown. The central building is two stories high,
and contains a ward on the upper floor for special cases of
disease. The two wards in the pavilions are for 28 patients
each. These wards are 25 feet wide, 80 feet long, and 14
feet high, to the eaves. The walls will be of brick through-
out, studded and plastered. The wards will be unceiled,
the rafters being plastered to the ridge, which is left open,
as shown in the section, (Fig. 43.)

SECTION OF WARD, FORT DELAWARE HOSPITAL.

In Fig. 44 the ground-plans of the British regimental
hospital, proposed by the Commission of Inquiry, are given.
The kitchen is entirely detached from the main building,
which is two stories high. The wards are but one story.
Nothing is stated in regard to any special means for venti-
lation.

PRINCIPLES OF HOSPITAL CONSTRUCTION.

353

In the next place we come to the consideration of tem-
porary military hospitals.

The erection of temporary military hospitals is a subject
of vast importance. If the army is engaged in distant
regions it often becomes necessary to build such structures,
and even on its own soil no government can maintain as

354 A TREATISE ON HYGIENE.

permanent institutions a sufficient number of hospitals to
meet the wants of a large army in time of war. The plans
to be followed in the construction of these temporary hos-
pitals will be best made apparent by descriptions of some
of those which have been built since the commencement of
the rebellion. It will be found that never before have such
vast structures been erected for the reception of the sick
and wounded of an army, or so much care bestowed by a
government in providing them with everything calculated
to add to the comfort of their inmates. Millions of dollars
have been spent in building these hospitals, and millions
more in fitting them up. Especial care has been taken to
secure every hygienic advantage in the way of fresh air,
abundant light, an ample supply of water, efficient drain-
age, etc., until, except as regards the less permanent char-
acter of the material of which they are built, these tempo-
rary military hospitals rival in the completeness of their
arrangements the best permanent hospitals of the world.*

The present chapter concerns only those institutions
which belong to the class called general hospitals. Gen-
eral hospitals are usually placed beyond the immediate
vicinity of an army, and are intended for the reception of
the sick and wounded, irrespective of the regiment or corps
to which they belong. Field and regimental hospitals will
engage attention in a subsequent chapter.

In the selection of sites for military hospitals the prin-
ciples already enunciated should prevail as far as is prac-
ticable. On many accounts it is best to place them in the
vicinity of cities or large towns. They are thus generally

* I wish to express my high appreciation of the liberality and en-
lightened views with which the Quartermaster-General has acted in
ordering the construction of the hospitals desired, and of which plans
were furnished by the Medical Department, and for the solicitude he has
always manifested to do all in his power to assist the medical officers in
their efforts to provide for the sick and wounded of the army.

PRINCIPLES OF HOSPITAL CONSTRUCTION. 355

of easier access, and are more within reach of the supplies
of various kinds which are required to maintain them.
They should not be too far from the army to which they
are more immediately attached, nor too near to impede
operations, or require large forces for their protection.

They should consist but of one story, both on account of
the greater facility with which one-story buildings are ad-
ministered, and because the noise, which would incommode
those of the lower wards, from the patients and others
walking on the floors of the upper, is avoided. Each ward
should be isolated from its fellows. Experience has defi-
nitely established the propriety of this measure, and it is
now carried out in all well-planned hospitals, whether civil
or military. Each ward should have its own latrines, bath
and ablution room, and nurses' room. It should be raised
at least one foot above the ground, the space below being
left open to the outside air.

The ventilation for summer should be provided for by
leaving an opening, ten inches wide, at the ridge, along the
whole length of the ward. This opening should be cov-
ered by a roof projecting at least two feet on each side, and
elevated about four inches above the lower roof. A nar-
row strip should be placed along the margins of the opening
to still further guard against the entrance of snow or rain.
The arrangement is shown in section in Fig. 43.

Holes should be cut in the sides of the wards under the
beds, capable of being closed by a sliding-door, so as to
allow of the free entrance of the external air.

This system of ventilation is very effective. The sun
heats the roof whereby an upward current is established,
and the air of the ward is constantly kept renewed. Such
wards are always comparatively cool and fresh. The ex-
perience of the summer of 1862, when many hospitals ven-
tilated on this principle were in operation, and when they
were, from the large number of sick and wounded suddenly

356 A TREATISE ON HYGIENE.

thrown upon them, crowded to the utmost limits consistent
with sanitary requirements, demonstrated that the air was
always cool, and free from offensive odors.

In the northern parts of the United States it may be-
come impracticable to keep these ventilators open during
the winter months, and at the same time maintain the neces-
sary degree of heat in the wards. In such cases other means
of ventilation are rendered necessary. The arrangement
adopted in the military hospitals is based upon the prin-
ciple of introducing, in cold weather, all the fresh air
required for the constant change of the atmosphere within
the wards at or near the stove, so that it shall be moder-
ately warmed before entering the room, and thus in a
measure to avoid the unpleasant cold currents so annoying
in a room heated exclusively by direct radiation.

If the means of exit for the vitiated air are sufficient in
a room heated by an ordinary stove, the air enters from
without with the external temperature, through any cracks
about the doors or windows, and thus irregular currents
are excited.

To obviate this difficulty, and at the same time provide
a sufficient amount of fresh air, holes are cut in the floor
under the stoves, and fresh air is brought to them by means
of wooden boxes passing between the floor and the ground
to the side of the building. A zinc jacket partially incloses
the stove, and serves the purpose of retaining the air long
enough in contact with the heated metal to receive a por-
tion of its temperature. By this means fresh air is pro-
vided and is heated before it is distributed throughout the
ward.

For the exit of the impure air square wooden boxes are
erected in the ward, passing from the floor through the
ridge of the roof. These boxes are open on two sides near
the floor, and one side consists almost entirely of a door
extending throughout nearly the whole length of the shaft.

PRINCIPLES OF HOSPITAL CONSTRUCTION.

357

To each stove there is one of these shafts or boxes, and in
order to cause a current through them the stove-pipes pass
into them and thus emerge from the roof. The arrange-
ment is shown in perspective in the accompanying cut,
(Fig. 45.) The results obtained from this system have
been exceedingly satisfactory. It is extremely simple, and
is easily regulated.

Fig. 45.

WINTER VENTILATION OF TEMPORARY HOSPITALS.

During the late war with Great Britain several tempo-
rary general hospitals were erected, and were highly com-
mended at the time for their completeness. In order that
it may be seen how wretched these structures were, and
how erroneous were the principles which then prevailed
relative to sanitary matters, I transcribe the following

358 A TREATISE ON HYGIENE.

extracts from the work of Dr. Mann,* then a surgeon of the
army.

"Dr. Tilton, Surgeon-General of the Army, with a mind
possessing correct principles of philosophy, desirous of in-
troducing a system of economy creditable to himself, sug-
gested hospitals upon a novel plan. They are built one
story in height with round logs, having a fire-place or
hearth in the center; without a chimney, the smoke venti-
lated through an inverted wooden funnel affixed to an
opening in the roof; the floors of the rooms earth, in the
true aboriginal style. He thinks them an improvement
as they respect health. Hospitals of this description, he
believes, obviate diseases which have their source from im-
pure air of crowded rooms, which is generated from animal
filth. The doctor is believed to be correct in his observa-
tions so far as wooden floors retain infectious principles,
while earth floors absorb or neutralize them. Examples
are not wanting to demonstrate that infectious principles
attached to wood retain their activity during a long time.
An improvement which is truly philosophical in theory,
cannot be carried into practice under all circumstances.
The plan proposed may, in southern districts or milder cli-
mates, fulfil the benevolent intentions of its learned pro-
jector. These hospitals are for winter months. During
the hot seasons, tents are the best military hospitals.
When snow covers the earth to a considerable depth, it
dissolves next the surface. The water irrigates under the
bottoms of the timbers which compose the outer wall of
the hospital, by which the earth floors are rendered uncom-
fortable from moisture, and the beds dirty. In a hospital
on the above plan the smoke, in its ascension, may convey
with itself infectious principles, but it aggravates cough

* Medical Sketches of the Campaigns of 1812, '13, and 14 etc Ded-
ham, (Mass.,) 1816, p. 240.

PRINCIPLES OF HOSPITAL CONSTRUCTION. 359

and complaints of the heart, which accompany the winter
diseases on the northern frontier.

" These hospitals are more expensive than those built
with framed timber and plank, excepting where the timber
stands in the vicinity of the spot where erected. Upon a
fair calculation made by the Assistant Quartermaster-Gen-
eral at Plattsburg, where it was necessary to draw the
timber one mile, the expense of erecting log hospitals upon
Dr. Tilton's plan was greater than with planked or boarded
sides. The consequence was, the Quartermaster-General
absolutely refused to give his assistance to erect them upon
the plan proposed by the Surgeon-General. The experi-
ment to demonstrate their usefulness was but partial at
French Mills, where the army remained only a short time.
No other attempts were made within my knowledge to
prove them excepting at Brownville, under the direction of
Hospital Surgeon Blood, who it was said reported favorably
of them."

It would be difficult to devise a more objectionable plan
for hospitals than that proposed by Surgeon-General Til-
ton. A ground floor is, of all others, the worst, for the
very reason that it absorbs readily the organic matters
given off from the bodies of the inmates. Instances of its
deleterious influence in this respect will be given hereafter.

Dr. Mann's own ideas of a hospital will be perceived
from the following extracts : " The wards of a military
hospital should have an east and west aspect, with win-
dows on each side. On the west a closed passage should
extend the length of the hospital, 12 feet wide, into which
the doors of the several wards open. The passage should
be furnished with windows which correspond with those
of the wards. This passage will be commodious for the
patients able to walk, where they will be secure from cold
and wet. In front of this should be an open piazza, pro-
jecting 10 feet, where the patients may walk unexposed to

360 A TREATISE ON HYGIENE.

the rajs of the sun in hot weather. By means of two
walls and the roof of the piazza heat will be excluded the
rooms, which is at its highest in hot seasons after the sun
has passed the meridian. These walls will also secure the
wards from cold during the severe frosts of winter.

"Wards of an extensive hospital should be 30 feet by 24
in dimensions, and not less than 11 in height, which may
accommodate 20 patients if not sick with contagious dis-
eases. This number in a ward requires only two nurses
when their diet is prepared in kitchens. The wards of
Burlington Hospital (which had the reputation of being
under the best regulations of any in the northern district)
are 25 feet by 20, and 9 feet high. These rooms were
found by experience to be too low. The windows of the
wards should be constructed so that the upper sash may
fall and the under rise at pleasure, that when ventilating
them the air may have free access to the rooms without
passing in currents immediately over the beds of the sick."

In wards of the size recommended by Dr. Mann, each of
the 20 patients would have 36 square feet of surface and
396 cubic feet of space, less than half they now receive in
the most crowded of our military hospitals. The wards
are also badly arranged, as they appear to join each other,
and the windows on one side open into a closed passage.
No means of ventilation, other than the windows and fire-
places, were provided. The rules which were in force rela-
tive to the management of the Burlington Hospital, which
for a time was under Dr. Mann's charge, were very excellent.

During the Mexican war no hospitals were constructed.
The sick who were invalided went to the general hospital
at New Orleans barracks, or to the barracks at Pascagoula.
In Mexico, churches, convents, and other public buildings
were made use of.

In the various Indian wars in which the country has
been engaged the temporary hospitals erected have been of

PRINCIPLES OF HOSPITAL CONSTRUCTION. 361

the most elementary character. This has in the main
been due to the peculiar circumstances in which the forces
were placed, preventing facilities for obtaining proper ma-
terials to be used in the construction and fitting up of hos-
pitals. Generally they have been built of logs. In New
Mexico, adobes (sun-dried brick) have been usually em-
ployed. Hospitals built of this material, though warm in
winter and cool in summer through the thickness of their
walls, are unhealthy, on account of the earthy walls absorb-
ing the effluvia from the inmates. I have seen several
cases of pyemia in such hospitals, which I am satisfied
were due to this cause.

Owing to the large army maintained by the United
States for the purpose of crushing the rebellion, many tem-
porary hospitals became necessary. At first very little
attention was paid to the planning of these structures; but
as the wants of the army for hospital accommodation in-
creased, more care and study were given to the subject of
providing the means for sheltering the sick and wounded
of the army.

The first pavilion hospital with ridge ventilation was
constructed at Parkersburg, in the Department of Western
Virginia. It consisted of an administrative building and
two detached pavilions. It was planned by Assistant Sur-
geon Dunster, United States Army, from data which I gave
to him as the result of the experience of the British Army
in the Crimea. Another was soon afterward built at Graf-
ton in the same department.

Two larger and more complete structures, planned by
the Sanitary Commission, were about the same time com-
menced in Washington City. The ground-plan of one of
these, the Judiciary Square Hospital, is represented in the
accompanying cut, (Fig. 46:) a a, administrative depart-
ment ; b b, wards ; c c, kitchens ; d, guard-house ; e, dead-
house. The other, situated at Mount Pleasant, a short

362

A TREATISE ON HYGIENE.
Fig. 46.

PRINCIPLES OF HOSPITAL CONSTRUCTION. 363

distance beyond the city limits, is of like plan. The
arrangement of the pavilions is similar to that followed
in the Blackburn Hospital, (Fig. 34,) the administrative
building being placed at one end instead of in the center.
This latter is two stories high, the ward pavilions being
but one. The ventilation is by zinc pipes in the roof
and by an upper row of windows, capable of being
opened and closed by cords. The corridor is wide, and
the wards of ample size. The original plan placed the
water-closets at the distant extremities of the wards, but
they were changed to the other end, against the advice
of the Commission, on the score of less cost of construc-
tion. A worse arrangement could not possibly have been
devised than that which now exists. It is even worse
than that which prevails in the south wards of the West
Philadelphia Hospital, to which allusion will presently be
made.

Another objectionable feature in these hospitals is that
the partitions separating the wards from the corridor do
not extend to the peak of the roof. It is thus possible to
throw a stone, for instance, from one ward into another,
and thus all the advantages of the pavilion system are lost.

The buildings are well supplied with water, and are
lighted with gas. They will accommodate 25 patients in
each ward, with 1200 cubic feet of space to each, making a
total of 250 to each hospital.

These were, however, comparatively small hospitals;
larger ones soon became necessary.

On the 1st of May, 1862, a larger and more imposing
structure was commenced in West Philadelphia. This
hospital is located at the intersection of Forty-fourth and
Spruce Streets, half a mile outside of the limits of the
City of Philadelphia. It is built upon an eminence, about
two hundred feet above the bed of Mill Creek, and distant
from it two hundred and fifty feet. Its situation has been

364 A TREATISE ON HYGIENE.

proven to be eminently healthy. The West Philadelphia
Hospital is well and strongly built of wood, lathed and
plastered on the outside. Its entire cost, exclusive of the
furniture, exceeds 200,000 dollars. Two corridors, origin-
ally each 740 feet in length, are connected with a central
administrative building two stories high. This building is
71 feet in width and 63 deep. The lower floor has a hall
running through it into which seven rooms open. These
are the surgery, reception-room, officers' mess-room, and the
several offices necessary for the transaction of the business
of the hospital. On the second floor are twelve rooms,
which are used as officers' quarters. Two other detached
buildings, on the east side, are also appropriated to this
purpose.

The corridors, which join the administrative building,
are 71 feet apart. They are each 14 feet wide, 13 high,
and, originally, 740 feet long. Latterly they have been
extended, and are now 860 feet long. These and the
pavilions are one story high. The corridors are used as
mess-halls, and answer the purpose admirably, as the
wards open directly into them.

The pavilions are 167 feet long, 24 feet wide, and 13
feet high at the eaves. The pitch of the roof is 6 feet,
and hence the height of the wards to the ridge is 19 feet.
They are not ceiled. The pavilions are twenty-one feet
apart.

Originally the number of pavilions used as wards was
twenty-eight, and they were of uniform length. Latterly
the number has been increased to thirty-four, by the addi-
tion of six at the east end of the structure. The accom-
panying cut (Fig. 47) represents a ground-plan of the
building as it now stands. The pavilions on the south
side were all extended as far as the ground admitted, so
that they are now of unequal lengths: a, administrative
building; b b, ward pavilions; c c, kitchens; d d, laundries;

PRINCIPLES OF HOSPITAL CONSTRUCTION. 365

Fig. 47.

SCALE raW

GROUND PLAN OF WEST PHILADELPHIA HOSPITAL.
24

366 A TREATISE ON HYGIENE.

e, chapel ; / /, store-rooms ; g, mess-rooms, band, etc. ; h h,
officers' quarters ; i, boiler-room ; k, residence of surgeon in
charge; I, water-tanks ; m, barber-shop; n, printing-office;
o, boiler and tank; p p, smoking-rooms; q, reading and
lecture-room; r, knapsack-room; s, guard-room; t, stable;
u, guard.

The wards upon the north side, with the exception of
the three at the east end, are each 147 feet long, 20 feet
being taken off for water-closet, bath-room, passage, ward-
master's room, and sisters' room. The two latter are at
the end joining the corridor; the water-closet and bath-
room are at the distant end, and are separated from the
ward by a passage three feet wide, running entirely across
the pavilion. The water-closet is arranged with a cast-iron
receiver or trough 12 feet long, 1 foot deep, and 1 foot 7
inches wide. It is kept partially filled with water from a
pipe entering at one end, and the accumulations are drawn
off at the other by means of another pipe emptying into
the common sewer. Each bath-room is supplied with a
cast-iron tray, over which water-pipes are laid, and in
which the water-basins are placed and a cast-iron bath-
tub, furnished with hot and cold water.

There are 24 windows in each of the original wards, 12
on a side. They are 6 feet 8 inches high, and 2 feet 7
inches in width. Between every two windows the beds
are placed, so that the proper capacity of each ward is 48
beds. The superficial area of each of these wards (24 x
147) is 3428 square feet, equal to a little over 71 square feet
to each bed. As the mean height of the ward is 16 feet,
the total cubical contents are 54,848 feet, which affords an
allowance of 1141 cubic feet of space to each bed. As the
wards are well ventilated at the ridge, this quantity is
amply sufficient to provide against overcrowding. The
details of a pavilion are given in Fig. 48 : a, ward; b, ward-

PRINCIPLES OF HOSPITAL CONSTRUCTION.

367

master's room; c, sisters' room; d, water-closet; e, bath-
room.

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Hot water is distributed, by means of iron pipes, to all
parts of the building, from an iron tank placed in each

368 A TREATISE ON HYGIENE.

kitchen. The water in the tank is supplied from the
main, and is made hot by steam from the boiler in the
front yard. The same boiler furnishes heat for the greater
portion of the cooking that is done in both kitchens.

The arrangements for cooking in each kitchen are a
large range, two large stoves, and three boilers, each hold-
ing 60 gallons.

The laundries are supplied with large cauldrons— the
water of which is heated by steam — washing-machines,
mangles, wringers, etc.

The wards are, as has been said, ventilated at the ridge.
Twenty of them (the first built) by the method shown in
section (in Fig. 49) a, and the remainder as shown at b.
In the first the sides admit of being closed by means of
cords acting on valves, but in practice this plan is not
found to be so good as the other.

These ventilators extend the whole length of the ward.
The opening in the roof is lh feet wide, the elevation of
the ventilator above the roof of the ward 8 inches, and the
width of the roof of the ventilator 3 feet 6 inches on each
side. The first-named ventilators do not extend the entire
length of the wards, being but 136 feet long. The height
above the roof is 3 feet 6 inches, and the width (corre-
sponding to the opening in the roof) 3 feet 11 inches.

The sewerage of the hospital is good. Two ten-inch
earthenware pipes, laid in the ground too deeply to be
affected by the frost, run along the ends of the wards,
and receive the pipes from the bath-rooms, water-closets,
laundries, kitchens, etc. They unite at the east end of
the hospital and empty into a twelve-inch pipe, which
leads into a sink, from which the fluid drainage is carried
off into Mill Creek. This sink is arched over, and is one
hundred yards from the hospital.

The supply of water is sufficient, and is derived from
the Schuylkill River through the West Philadelphia

PRINCIPLES OF HOSPITAL CONSTRUCTION.

369

370 A TREATISE ON HYGIENE.

works. To provide against all possible contingencies, three
tanks, holding over 75,000 gallons, have been erected.
Ample provision against fire is made through numerous
plugs and sections of hose in the corridors.

The original capacity of this hospital was 1344 beds, the
28 wards containing 48 beds each. But during the active
campaigns of the summer and autumn of 1862 it became
necessary to provide for a large additional number of pa-
tients in this institution. This was done both by erecting
a number of hospital tents and putting up more beds in
the wards. As soon as possible these latter were taken
out, and to provide for those in tents, at the approach of
winter, the wards of the south side were extended, accord-
ing as the ground permitted, and six additional wards were
built. By the extension of the pavilions, the water-closets
on that side were thrown entirely within the wards, a re-
sult which is certainly to be condemned on hygienic
grounds, and which will probably lead to serious incon-
venience during warm weather if the additions are used
for patients. It will be better therefore not to occupy the
extensions as wards during the summer months.

At present the full capacity of the West Philadelphia
Hospital is 3124 beds. It is the largest in the United
States with one exception, (Chestnut Hill,) and with that
exception the largest in the world intended solely for sick
and wounded persons. Since its organization, and indeed
since the work was commenced on it, it has been under
the charge of Surgeon I. I. Hayes, United States Volun-
teers, and to his excellent management is mainly due the
capital hygienic condition in which it has always been
found. All the advantages of the building have been
brought out, and every measure taken to lessen the evils
which were liable to result from its objectionable features,
with the one exception of extending the wards so as to
change the relative position of the water-closets.

PRINCIPLES OF HOSPITAL CONSTRUCTION". 371

The "West Philadelphia Hospital is by no means a per-
fect structure. The corridors are too close together, and
the distance between the pavilions should be at least ten
feet greater than at present. The water-closets are con-
structed after a bad plan, and though the trough may be
regularly emptied every hour, the excreta remain in it that
long, and render the air of the wards more or less impure.
The extension of the pavilions on the south side has added
to the evil. Wards have thus been constructed, which, as
they now stand, are in opposition to the plainest teachings
of sanitary science. Either the water-closets should be
placed in the distant end of the wards on the south side,
or the new parts of these wards should be emptied of pa-
tients as soon as warm weather sets in. One or the other
of these measures will be carried out. The difficulties in
the way of moving the water-closets were great, as the
main sewerage pipe on that side passed immediately
under them, and could not have been removed without
an expense not thought justifiable at that time.

In all other respects the West Philadelphia Hospital is
a credit to the army. The discipline has always been ex-
cellent, and the patients have been well cared for. The
difficulties to contend with in the management of so vast
an institution as this can scarcely be conceived by those
who have not personally visited it and studied the system
by which it is governed. The number of medical officers
is at present fifty-two, besides eighteen medical cadets.
The cooks, nurses, and other attendants number four hun-
dred and sixty-four. There are also three chaplains.

A printing-press belongs to the hospital, and a news-
paper is regularly published once a week. A large library
and reading-room is also not the least of the hygienic

advantages.

The largest and most complete military hospital in the
United States is the Mower General Hospital at Chestnut

372 A TREATISE ON HYGIENE.

Hill, within the city limits of Philadelphia, but situated in
one of the rural districts, away from the confusion and bad
air of the thickly settled parts of the city.

It is the largest institution in the world devoted to the
reception of sick and wounded alone. The Salpetriere of
Paris, though containing 4422 beds, cannot be considered
a hospital in the strict sense of the word, as insane per-
sons, idiots, and paupers constitute the bulk of its inmates;
and the Bicetre, with its 3118 beds, occupied in great part
by the same classes, falls short in magnitude of the im-
mense hospital at Chestnut Hill. Even the Grand Hos-
pital of Milan, when filled to its utmost capacity, (2702
beds,) has 600 less than the institution under considera-
tion. The Allgemeines Krankenhaus of Vienna, the
largest hospital in Germany, contains about 2000 beds.
The Chestnut Hill Hospital contains 2820 beds for pa-
tients, besides 500 for the officers, stewards, nurses,
cooks, etc.

The Mower Hospital — so called after the late Dr. Mower,
for many years the senior surgeon of the army, and beloved
and respected by all who knew him — is situated on an
elevated plateau, from which the drainage is excellent.
It is constructed of wood in the best manner, lined with
smooth planks on the inside and lathed and plastered on
the outside. Its cost has been over 250,000 dollars, ex-
clusive of the furniture. As a temporary hospital it has
never been equaled in the completeness of all its arrange-
ments, which have been carried out on a scale and with a
thoroughness worthy of a permanent institution. It will
last, without extraordinary repairs, for at least ten years.
The Chestnut Hill and Philadelphia Railroad passes close
to it, so that patients can be brought from the Army of the
Potomac for instance, without the necessity of changing
from the car in which they were originally placed.

Fig. 50 represents the ground-plan of the hospital at

Fig.

MOWER GENERAL HOS!

:50.

;?ITAL, CHESTNUT HILL

PRINCIPLES OF HOSPITAL CONSTRUCTION. 373

Chestnut Hill. It is seen to be composed of 50 pavilions,
projecting from a corridor of a flattened ellipsoidal form.
This corridor is 16 feet wide and 2400 long. The ground
inclosed by it measures 653 feet in its long diameter, and
522 feet from side to side ; the area inclosed is therefore
341,466 square feet: A, indicates the building in which
the principal offices are contained ; B, kitchen and engine-
room, etc.; C, barrack for band, nurses, and other at-
tendants ; D, provision store-rooms ; E, barrack for guard,
and knapsack-room.

The sides of the corridor are almost entirely composed
of glass set in sashes, which in summer are entirely re-
moved. During inclement weather they are closed, and
the corridor being furnished with fifty large stoves, an ex-
ercise hall, for those patients able to leave their wards, is
thus at command.

The pavilions are arranged in radii, and are 20 feet
apart at the corridor and 40 at the distant extremities.
The circulation of the air around them is thus secured.
The entire length of each pavilion is 175 feet, and the
width — exclusive of the water-closet and scullery, which
project from the pavilion— 20 feet. The height to the
eaves is 14 feet, and to the ridges 19 feet. The roof has
thus a pitch of 5 feet. The length of the ward is 150 feet,
the remaining 25 feet of the length of the pavilion being
taken up by the mess-room at one end, the wash-room and
wardmaster's-room at the other. As each ward contains
52 beds, there is an allowance of a fraction less than 60
square feet and 950 cubic feet to each patient when the

ward is full.

The water-closets are well arranged, the excreta being
carried off at once by a full stream of water. The bath-
room is furnished with a cast-iron bath-tub, to which
hot and cold water are supplied. The ablution-room is
also supplied with hot and cold water. The scullery, at

374 A TREATISE ON HYGIENE.

the other end of the ward but outside of it, is fitted with
sinks, over which hot and cold water are laid.

To each ward at the end joining the corridor a mess-
room is attached, sufficiently large for the use of those pa-
tients able to leave their beds. The food is brought to
these rooms in hot-water cars running on a railway laid in
the corridor throughout its entire length. By this means
the meals are served hot from the kitchen, with which
the railway is immediately connected. This railway also
serves for the transportation of patients to their wards,
and for carrying fuel, furniture, etc.

The details of a ward pavilion are shown in ground-plan
in Fig. 51 : a, ward; b, mess-room; c, scullery; d, bath-room;
e, water-closet; /, ablution-room; g, wardmaster's-room.

Fig. 51.

10 5 O 10 20 SO 40 SO GO 70 80 SO 100

GROUND-PLAN OF WARD PAVILION OF CHESTNUT HILL HOSPITAL.

The kitchen and laundry do not differ in their arrange-
ments from those already described as existing in the West
Philadelphia Hospital. Hot water from the large boilers
is supplied to them by a steam-engine, which also forces it
to the other parts of the hospital. Over 150,000 gallons
of water are used daily, which is an average of about 50
gallons to each inmate.

The sewerage is very efficient. The administrative
buildings and wards are all lighted with gas.

PRINCIPLES OF HOSPITAL CONSTRUCTION". 375

The personnel of the hospital consists of 30 medical
officers, 8 hospital stewards, 3 chaplains, and 495 cooks,
nurses, and other attendants. There is besides a guard of
86 men.

The hospital was organized by Surgeon Jos. Hopkinson,
United States Volunteers, under whose charge it is at
present, (April, 1863,) and who, by his efficient and sys-
tematic exertions, has harmonized all the arrangements of
the vast establishment.

It should be mentioned that a magnetic telegraph and
fire-alarm apparatus connects all the wards and offices with
the office of the surgeon in charge.

The only defect of any material consequence in the
Chestnut Hill Hospital is the narrowness of the wards.
They should be not less than four feet wider. Owing to
this deficient width, the beds placed opposite the places
occupied by the stoves must either be taken out, or turned
with their length corresponding to the length of the ward,
when the stoves are heated.

The ventilation is along the whole ridge in summer, and
by the method already described for cold weather.

The ground inclosed by the hospital measures about
seven acres, and affords ample space for an exercise ground
for the patients. A healthier spot than the situation of the
hospital is not to be found in the vicinity of Philadelphia.

Another very admirably planned hospital, and in some
respects superior to that at Chestnut Hill, the McClellan,
is also situated in the neighborhood of Philadelphia. The
pavilions for wards are similar in general features, and are
of the same size as those of the Chestnut Hill Hospital.
The arrangement of them with reference to each other is
somewhat different. A corridor of a flattened ovoidal form,
inclosing a surface 550 feet long and 150 wide, connects
the pavilions, which radiate from the opposite extremities
only, instead of from the whole circumference, as in the

Fig. 52.

McCLELLAN HOSPITAL, PHILADELPHIA.

PRINCIPLES OF HOSPITAL CONSTRUCTION. 377

Chestnut Hill Hospital. The distance between the pa-
vilions is greater than in the last-named hospital, and the
whole system is less crowded. The administrative build-
ing is in the center, being connected with the main corri-
dor by two straight passage-ways. All these corridors are
open in summer. The kitchen and other offices are on the
outside. Fig. 52 represents the ground-plan of this hos-
pital: a, the main corridor; b b, wards; c, administrative
building, which is two stories high; d, kitchen; e, laundry;
/, clothing and guard-rooms; g, engine-room; h, stable; i,
provision and knapsack store-room; h, quarters of medical
officer in charge.

This hospital has 1040 beds — 52 in each ward. Like
the Chestnut Hill Hospital, it is supplied with water and
gas, and has an efficient system of drainage. A steam-
engine forces hot water from a boiler to all parts of the
hospital.

The Hammond Hospital at Point Lookout, at the junc-
tion of the Potomac River with Chesapeake Bay, is one of
the best, in every respect, belonging to the army. The
situation of this hospital is such that the patients have the
advantages of salt-water bathing and sea air. It is remark-
ably salubrious.

The hospital consists of 16 pavilions projecting from a
circular open corridor. The pavilions are each 145 feet
in length by 25 in width, 14 feet high at the eaves, and
18 at the ridge. They are built of wood in a substantial
manner; are plastered inside but unceiled. They are ven-
tilated throughout their entire length at the ridge. Fig.
53 represents a ground-plan of this hospital: a, the admin-
istrative building; b, wards; c, kitchen; d, laundry; e,
guard-house; /, knapsack-room; g, dead-house. Open cor-
ridors lead from opposite points of the circular corridor to
the buildings in the center. Each ward has 24 windows,
besides 2 side doors, and is capable of accommodating 52

378

A TREATISE ON HYGIENE.

patients. At one end is a mess-room, and at the other, the
farther from the corridor, a bath-room, water-closet, and

Fig. 53.

GROUND-PLAN HAMMOND GENERAL HOSPITAL, POINT LOOKOUT.

nurses' room. The elevation and ground-plan of a ward
are shown in Fig. 54; and in Fig. 55 a transverse section
of a ward is given, a; b and c represent transverse sections
of the straight and circular corridors, and d a side view of
a portion of the latter. The length of the circular corridor
is 1001 feet, and the diameter of the space inclosed 318
feet.

Each patient in a ward of this hospital has 70 square
feet of surface and 1116 cubic feet of space. Considering

PRINCIPLES OF HOSPITAL CONSTRUCTION.

379

the excellent means for ventilation, the wards being 36
feet distant from each other at the circular corridor, and

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75 at the other end, and the constant prevalence of a
fresh pure breeze, this allowance may be considered

380

A TREATISE ON HYGIENE.

ample. Water is supplied from tanks which are filled
from wells, and is heated by steam. The washing is done
by machinery. The administrative building contains the
various offices necessary for conducting the business of the
hospital. Numerous cottages in the immediate vicinity of
the hospital, and forming a part of its organization, are
used as quarters for the officers and such of the attendants
as can sleep outside of the hospital proper.

Fig. 55.

3 C A L E aw

SECTIONS OF WARD AND CORRIDORS, POINT LOOKOUT HOSPITAL.

As there are 15 wards, of 52 beds each, the capacity of
this hospital is 780 beds. Since its organization it has
been under the charge of Assistant Surgeon Clinton
Wagner,' United States Army, who has, by his excellent
management, made it a credit to the service.

The hotel and cottages — Point Lookout, previous to the
rebellion, having been a watering-place of some import-
ance — are also used for the accommodation of patients,
making the entire capacity of 'the hospital 1700 beds.
The number of medical officers at present is 14 ; medical
cadet 1 ; hospital stewards 5 j and nurses, cooks, etc. 192.

PRINCIPLES OF HOSPITAL CONSTRUCTION.

381

The plan of the hospital at Point Lookout presents sev-
eral features of interest in a hygienic point of view. The
peculiar arrangement of the wards allows of the freest cir-
culation of air about them, and at the same time admits of
the establishment being easily administered. There is the
most complete isolation of the pavilions consistent with
efficient administration.

Fig. 56.

SEINE R.
■ yemm > -

POYET'S PLAN FOR HOSPITAL FOR 5000 PATIENTS. PARIS, 1786.

Among the plans submitted for the construction of a
large hospital in Paris, after the burning of the H6tel-Dieu,
was one for 5000 beds by Poyet. A commission of the

382 A TREATISE ON HYGIENE.

Academy reported favorably in regard to this project,* but
it was not adopted. A representation of this plan is given
in Fig. 56. Its inferiority to that at Point Lookout is at
once seen, though there is great similarity between the
two.

Several large hospitals have been constructed upon a
plan which has many points to recommend it, though it is
not so well adapted to this climate as that followed at
Chestnut Hill and Point Lookout. Fig. 57, which repre-
sents the ground-plan and end elevation of a pavilion of
the Lincoln Hospital in Washington City, is an illustration
of the plan referred to. The arrangement is such that the
pavilions are placed en Schelon, and thorough ventilation is
thus secured. The administrative building is at the apex
of the hospital, and the kitchen, laundry, and other offices,
in the center of the inclosure. A covered corridor, open
at the sides, passes along each row of pavilions. This hos-
pital accommodates 1200 patients. The pavilions are
similar in their internal ' arrangements to those at Point
Lookout.

The General Hospital at Hampton, near Fortress Mon-
roe, is built after the same model, and is of the same size.
That at Portsmouth Grove, Rhode Island, is composed of
two such systems, the apices being close together, and the
whole forming a figure resembling the letter X. The only
difficulty connected with plans of this kind for large hospi-
tals is that of administration. In other respects no serious
objection can be urged against them.

One other hospital belonging to the army deserves spe-
cial mention, and that is the General Hospital at Fort
Schuyler, near the entrance of the East River into Long
Island Sound. The wards here are arranged tangential to
an oblong corridor, open at the sides. This position of the

* Etude sur les Hopitaux, etc., par M. Arinand Husson. Paris, 1862,
p. 29.

PRINCIPLES OF HOSPITAL CONSTRUCTION.

383

Fig. 57.

GROUND PL A N
S CALL toV,v

d n n

END ELEVATIOfJ
SCALE itt

LINCOLN HOSPITAL, WASHINGTON CITY.

384 A TREATISE ON HYGIENE.

wards secures the free circulation around them of the air
set in motion by the prevailing winds. The corridor is,
like the Chestnut Hill Hospital, furnished with a railway
by which the food, etc. are moved. The administrative
building is at one end and the kitchen and laundry at the
other. The wards are similar in their general features to
those at the Chestnut Hill and McClellan hospitals, the
water-closets and bath-room being entirely outside, at the
distant ends. Each ward contains 48 beds except those at
the end near the kitchen, which are but two-thirds the size
of the others. The total capacity of the hospital is 1600
beds. Fig. 58 shows a ground-plan of the whole establish-
ment. The hospital is situated on a narrow peninsula, and
is almost entirely surrounded by salt water. The location
is healthy, and is admirably adapted for the restoration to
health of those invalid soldiers who have been broken
down by service in malarious districts. It was organized
by and is still under the superintendence of Assistant Sur-
geon Roberts Bartholow, United States Army. Its hy-
gienic condition has always been excellent, and every
comfort and convenience is provided for its inmates.

Several other very good plans have been followed in the
erection of the large number of temporary hospitals which
have been required. In all, the pavilion system of ridge
ventilation has been enforced, except in one or two which
were built without a reference of the plans to the Medical
Bureau. Many of these, to which more specific reference
cannot, for want of space, be made, are large, containing
from 500 to 2500 beds, and are well arranged and con-
ducted. A hospital, the duplicate of that at Chestnut
Hill, is in course of erection at Louisville, Kentucky, and
other large ones at Nashville, Tennessee, and at Madison,
Evansville, and New Albany, Indiana.

In all these temporary hospitals particular attention has
been paid to ventilation, to the avoidance of overcrowding,

Fip. 58.

I U U

GENERAL HOSPITAL AT FORT SCIIUYLER.

386 A TREATISE ON HYGIENE.

and to supplying them with a sufficient amount of water.
In all places where water could be introduced from mains
it has been done, and provision made for heating it.
When practicable, gas has always been used for lighting.
The latrines have generally been of the most approved
forms, and the drainage efficient. The kitchens are large,
and, with the laundries, are furnished with every requisite
convenience. In many of the hospitals steam is used for
cooking and for heating water for washing.

The wards are furnished with iron bedsteads, and gen-
erally with hair mattresses. In some hospitals bed-sacks
filled with straw are preferred, on account of the facility
with which they can be removed. Hair is in all cases
supplied for the very sick. The objections to straw beds
are, that they become in a short time inelastic, and that
they abstract the heat too rapidly from the body. Hair is
undoubtedly preferable. Curtains to the beds are not used;
they are objectionable on account of the facility with which
they retain the exhalations of the patients. The French
still retain them.

Cotton sheets are, on some accounts, preferable to linen
for sick persons. They are warmer, and in cold weather
this is a point of some importance. Linen is, however, in
more general use.

The pillows are always of hair, and are inclosed in linen
pillow-cases.

Tables, chairs, trays, and other necessary articles of hos-
pital furniture for the wards, kitchens, and mess-rooms, are
supplied in requisite quantities.

The subject of the food of the sick will be considered
under another head. In the mean time, the principles
which should govern in the construction of field and
other more temporary hospitals than those which have
been brought under notice in the present chapter, require
attention.

FIELD HOSPITALS. 387

CHAPTER XV.

FIELD HOSPITALS.

It often becomes necessary to establish field hospitals with
great promptness, and therefore it is at such times impos-
sible to comply with all the conditions which a regard for
the health and comfort of the sick and wounded dictates.
Barns, dwelling-houses, and other buildings in the vicinity
of a field of battle are appropriated and fitted up as hospitals,
with such conveniences as may be at hand. It is of course
out of the question for an army in the field to carry with it
bedsteads, mattresses, and other bedding, except blankets;
and even cooking utensils, besides those contained in the
hospital mess-chests, must be left in the rear; but with
plenty of straw, a few tins, and the essence of beef, con-
densed milk, and coffee, and other hospital stores, which,
if an army is victorious, can generally be brought up, the
sick and wounded can be placed in a condition of compara-
tive comfort.

Tent Hospitals. — The best field hospitals, both for sum-
mer and winter, are tents. Even in the coldest weather
these can be made exceedingly comfortable by the small
camp-stoves which are issued. After the battle of Antie-
tam a field hospital was established at Smoketown, near
the battle-field, under charge of Surgeon Vanderkieft, which
may be considered a model for such establishments. Hun-
dreds of wounded were treated at this hospital. It was
kept in operation through the entire winter, and had at
one time over one thousand wounded men in it.

In establishing field hospitals, one of the most important

388 A TREATISE ON HYGIENE.

points requiring attention is that of avoiding overcrowding.
A regulation hospital tent should never be made to contain
more than eight men as a maximum — six is a better num-
ber at all times. But it is sometimes impossible to regu-
late this matter according to the principles of sanitary
science. The wounded must be provided for, and if there
is a deficiency of 'hospital accommodation through any
exigency of the service, overcrowding must be the conse-
quence. The army hospital tent is fifteen feet square, is
made of heavy duck, and is furnished with a fly. It
is so made that two or more can be joined together, thus
forming a tent ward : not more than three should ever be
thus united. If it is probable that a field hospital thus
constituted will be maintained for any considerable length
of time, the tents should be floored.

A trench, eighteen inches deep, should be dug around
each tent or set of tents. Nothing will justify the omission
of this precaution. It is indispensable not only to the com-
fort of the inmates, but frequently to their lives. A drain
must be made from the trench to allow the water to run off.

The nature of the ground upon which a tent hospital
is established is of importance. It should be of such a
character as to absorb moisture, and should have a gentle
inclination. Sand and gravel in combination make the
best soil.

The several details of the organization and management
of field hospitals are matters of regulation, and do not
come within the scope of this work.

The conical tent is not well adapted for hospital pur-
poses. Having no perpendicular walls, ventilation cannot
be effected, as in the hospital or wall tent, by raising the
sides; moreover, in summer they are exceedingly hot, from
this inability to cause a free circulation of air through
them, and their not being supplied with flies to break the
force of the sun's rays.

FIELD HOSPITALS. 389

In order more effectually to ventilate the hospital tent, a
slit should be cut in the end near the ridge, and kept open
by a forked stick. The walls should be kept elevated
during the greater part of the day when the weather will
admit of it, and even in cold weather should be raised for
a short time every day.

If the tents are not floored, they should be struck once a
fortnight and the site changed, if only a few feet, should
the condition of the patients not positively contraindicate
it. The good effects of this measure can scarcely be over-
estimated. Fever cases, wounds, and most chronic dis-
eases are invariably benefited thereby. The floors should
be swept daily, and all accumulations of filth removed.

To repeat it, overcrowding is to be sedulously avoided.
It is the greatest danger the surgeon has to guard against,
and if he is obliged from necessity to put more men in a
tent or building than is proper, no time should be lost in
thinning them out. Dr. Mann* states that at Lewistown,
during the late war with Great Britain, two barns, each
forty feet square, were fitted up as hospitals. Floors of
inch plank were laid on joists raised to a level with the
sills of the barns. In each of these were placed one hun-
dred men, but they were too much crowded. As soon
as tents were furnished, more room was given by removing
a part of the patients, so that sixty patients were comfort-
ably accommodated in each barn. Dr. Mann says that
these were the most comfortable summer hospitals which
he saw during the campaign; and yet when they each con-
tained one hundred men, the allowance of superficial area
per patient was but sixteen square feet, so that the men
must have been absolutely in contact; and even when the
number of inmates was reduced to sixty, there were but a
little over twenty- six square feet per man.

* Op. cit., p. 249.

390 A TREATISE ON HYGIENE.

Hut Hospitals. — When there is a scarcity of tents, or if
the weather is extraordinarily severe, it may become neces-
sary to erect temporary huts or sheds to be used as hospitals.
The same principles should prevail in such cases as govern
the building of the general hospitals already described.
Every possible comfort and convenience should be obtained.
If this view is thoroughly acted on, it will be found that
the sick and wounded can be remarkably well provided for
even under very adverse circumstances. As huts are gen-
erally longer occupied than tents, it is proper to dwell with
some detail upon the manner after which they should be
built.

The sites should be such as to admit of easy drainage.
A clay soil, which, as has already been shown, is power-
fully retentive of moisture, should be, if possible, avoided,
and one of sand, with a sub-soil of gravel, preferred. The
ground should be slightly inclined, and, above all, should
be well trenched, so as to avoid any possible accumulation
of water. For obvious reasons, the huts should be placed
in the vicinity of wood and water.

The huts should be separated from each other by an in-
terval equal to twice the height of the huts, and should
be so arranged that the air will circulate freely around
them. They should not therefore be placed so that one
can stand in the way of another receiving the beneficial
effects of the wind, no matter from what quarter it shall
blow. The ordinary way of placing them was, till re-
cently, in a straight line, and this plan is still followed in
arranging the tents or huts of the troops even in perma-
nent camps. In camps formed by the troops when march-
ing there is not so much objection to this plan, but if the
stay is for several days it should be departed from. In
Fig. 59 this arrangement is shown.

Huts or tents placed in this order are not thoroughly
ventilated by the wind, unless it blows from the directions

FIELD HOSPITALS.

391

a or b. When it comes from the points c or d, the bad air
of the huts is carried along the line and accumulates the
noxious effluvia in its passage.

Fig. 59.

cm^>

In some camps which I have examined I have found the
tents or huts in actual contact — not in hospital camps,
however, there being few medical officers so ignorant of
their duty as to permit such a violation of the laws of
health when in their power to follow the teachings of
reason and experience.

The best of all arrangements for hospital tents or huts
is that by which they are placed en echelon, as shown in
the accompanying diagram, (Fig. 60.) Here the structures

Fig. 60.

are not only placed so as not to obstruct the free circula-
tion of the air about them, but the distance between any
two is equal to twice the height, and consequently the

392

A TREATISE ON HYGIENE.

effluvia from any hut, even if a portion should be blown
toward another, is so diluted as to lose the greater part, if
not the whole, of its noxious character.

Several large hospitals have been constructed upon plans
which are modifications of this and the following, (Fig. 61,)

Fig. 61.

which may be used when the ground will not admit of the
prolongation of a single line of huts or tents; and they have
been found to be exceedingly advantageous.

In Fig. 62 the huts or tents are arranged in the form of
a square, and so that the air will sweep freely around each,
no matter in which direction it blows.

In the erection of huts it is essential that the floors
should be raised a foot or eighteen inches above the
ground, and the space between the floor and the ground
should be left open, so as to allow the air to circulate freely
through it. In the Judiciary Square Hospital in Wash-
ington City a great mistake was committed in closing this
space. It cannot too strongly be impressed upon the
student of hygiene that confined air is always deleterious
to those subjected to its influence.

In tents or huts the same allowance of space is not re-
quisite as in permanent hospitals built of stone or brick.

FIELD HOSPITALS.

393

In these latter, as we have seen, the amount should not be
less than twelve hundred cubic feet and from eighty to one

Fig. 62.

hundred square feet, but in huts six hundred cubic feet
and between fifty and sixty superficial feet will be found
sufficient. This is the allowance recommended by General
Burgoyne* of the British Army, Inspector-General of Forti-
fications, and doubtless his opinion was given after full con-
sultation with, if not at the direct suggestion of, the medical
authorities. A distance of at least five feet should inter-
vene between the rows of beds, and the beds should be
arranged in pairs, as in the hospitals already described.

If the huts are built of logs, they should be well chinked
and plastered, and are much improved by the logs being
squared on the inside. If scantling and boards are used,
the walls and roofs should be lined, so as to leave an air

* Suggestions for the Construction of Wooden Huts for Barracks and
Hospitals, and for the adaptation of Buildings for Barracks and Hospi-
tals in the North American Provinces.

394 A TREATISE ON HYGIENE.

chamber of four inches between the outside and inside
walls. Such was the form of hut used in the Crimea by
the Naval Brigade, after the plan furnished by the Sani-
tary Commission sent to the East by the British govern-
ment. In their report* the Commission state that, after
selecting the site, —

"The ground was immediately cleared, leveled, and
drained. A foundation of large, rough stones — picked off
the adjacent surface — about a foot high, was formed, and
the timbers and flooring of the huts laid on these stones.
By this simple means the air was allowed to circulate
freely under the hut, and all risk of damp was removed."

The sides and roof of each hut were double, and a cur-
rent of air was allowed to pass upward in the space be-
tween the outer boarding and the inner lining, in the
manner already mentioned. As the result of this arrange-
ment, the temperature was the same inside the hut as it
was outside in the shade.

" Ridge ventilation was introduced, and the external air
was admitted a little above the level of the floor by simply
raising the lower edge of one of the boards a little outward
and one of the inner boards a little inward, to permit air to
enter." The provisions for ventilating the wards and carry-
ing off the hot air from the walls are shown in Fig. 63,
which represents a transverse section of one of these huts.

The windows were swung on pivots, and on account of
their small size were the most objectionable feature of the
hut. A covered porch was erected at each end, and the
eaves of the hut projected far enough to carry the water
away from the foundation. This hut was considered by
the Commission as a model for camp hospital purposes. It
certainly is very admirably conceived, and has been used

* Report to the Right Honorable Lord Panmure, G.C.B., etc., Min
ister at War, p. 142.

FIELD HOSPITALS.

395

as a pattern for many that have been built during the
present war.

Fig. 63.

CRIMEAN HOSPITAL HUT, NAVAL BRIGADE.

If material is scarce, or if from other causes it is imprac-
ticable to have the huts built with double walls, the plan
shown in Fig. 64 may be followed as the next best, the
windows being made, if possible, double the length indi-
cated. This figure also gives a good view of the ridge
opened so as to allow of ventilation. A transverse section
is shown in Fig. 65.

Huts were constructed in the Crimea with the sides
banked up with earth, and often with no means, or very

396

A TREATISE ON HYGIENE.

imperfect arrangements, for ventilating at the ridge. There
is a disposition in our own army to follow the same system,
and there is reason to believe that it has been productive

Fig. 64.

RIDGE VENTILATED HUT.

of a good deal of sickness. This subject will more fully
engage attention when we come to the consideration of
barracks and camps.

Fig. 65.

RIDGE VENTILATED HUT— TRANSVERSE SECTION.

For heating huts, nothing is equal to the open fire-place,
which, at the same time that it warms the hut, carries off
through the chimney a portion of the foul air. Stoves,
though they give out more heat, are less desirable on ac-
count of the sensation of closeness which they communi-
cate to the air. If they are used, the floor should be
opened under them, and air shafts, passing to the exterior
on both sides of the hut, arranged after the plan already
described.

In these temporary huts not more than twenty-five beds

FIELD HOSPITALS. 397

should be placed. Huts well built, according to either of
these plans, are far better, hygienically, than any perma-
nent hospital of brick or stone ever erected.

So far we have considered the wards alone. The ad-
ministrative building should be conveniently situated, and
the kitchens should be close enough to admit of the meals
being served hot to the patients. A mess-room for those
able to leave the wards should be connected with the
kitchen.

The camp hospital at New Creek, Virginia, which was
calculated for about one thousand patients, was composed
of two double echelmis, the apices pointing toward each
other. The administrative buildings were on the inside,
and the latrines on the outside. Latrines should be dug
at least some six or eight feet deep, and every day the
accumulations should be covered with powdered charcoal
and fresh earth. They should be situated as far as possible
from the source of the water supply of the hospital, and
should on no account be built over a stream of running
water, for by such a course the water would be rendered
unsuitable for those who might have to use it lower down
the stream. They should be placed on that side of the
hospital toward which the prevailing winds blow.

It will perhaps not be out of place again to insist upon
the great advantages of these temporary field hospitals
over those located in permanent buildings in towns.
Nothing is better for the sick and wounded, winter and
summer, than a tent or a ridge ventilated hut. The ex-
perience gained during the present war establishes this
point beyond the possibility of a doubt. Cases of erysipe-
las or of hospital gangrene occurring in the old buildings—
which were at one time unavoidably used as hospitals, but
which are now almost altogether displaced for the ridge
ventilated pavilions— immediately commenced to get well
as soon as removed to the tents. But in one instance that.

398 A TREATISE ON HYGIENE.

has come to my knowledge has hospital gangrene originated
in a wooden pavilion hospital, and in no instance, so far as
I am aware, in a tent. Hospital gangrene has been ex-
ceedingly rare in all our hospitals, but two or three hun-
dred cases occurring among the many wounded, amounting
to over one hundred thousand, of the loyal and rebel troops
which have been treated in them.

Again, wounds heal much more rapidly in them, for the
reason that the full benefit of the fresh air and the light
are obtained. Even in fractures the beneficial effects are
to be remarked.

Of course, to obtain the utmost degree of good from such
hospitals, it is necessary, as in everything else, that the
best medical officers should be placed in charge of them.
Men who not only know their duty, but who are possessed
of the requisite administrative ability to carry out the
measures which their judgment dictates. Something more
is needed than mere professional knowledge; an associa-
tion with military men and the acquirement of the habit of
commanding are indispensable. Some persons gain the
power quickly, others never acquire it. It is an error
therefore to suppose that because a medical man is a good
practitioner or an accomplished teacher that he is at once
qualified to assume the charge of a military hospital. Ac-
customed to practice in a city, with every convenience at
hand, civil physicians and surgeons are often lost when
they are thrown upon their own resources, and, knowing
nothing of the exigencies of a military life, are indignant
when the purveyors express themselves unable to comply
with their demands. The business of a military surgeon
must be learned like every other, but in times like the
present the scholars are apt, and vie with each other in
their efforts to render themselves useful to their country.

LIGHTING OF HOSPITALS. 399

CHAPTER XVI.

LIGHTING OF HOSPITALS.

All means in use for the artificial illumination of build-
ings produce contamination of the atmosphere, through the
evolution of deleterious substances, the result of combus-
tion. It is important in all dwellings that these products
should be removed, and it is especially so in hospitals,
where many sick persons, themselves giving off noxious
effluvia, are inmates of one room.

The substances employed to produce light in dwellings
are solids, liquids, and gases. Under the first class are
embraced candles of wax, spermaceti, stearine, parafnne,
lard, and tallow; under the second, certain fish and other
animal oils, vegetable oils, kerosene, naphtha, turpentine,
and several mixtures of this substance and alcohol ; under
the third, the ordinary illuminating gas, composed mainly
of carbon and hydrogen, and produced from the destructive
distillation of coal, or resinous or fatty substances.

If the matter is regarded from an economical point of
view, wax candles are the most expensive means of illumi-
nation; but if the subject is considered in its hygienic rela-
tions, they are to be preferred as the most healthy. In
burning they produce very little smoke or heat, and the
substances which arise from their combustion are not of
the most injurious kinds— margaric and oleic acids, with
a small quantity of carbonic acid, being the principal mat^
ters given off. Moreover, the light is neither intense nor
of a character to be disagreeable to the patients of a hospi-
tal ward.

400 A TREATISE ON HYGIENE.

Stearine in burning produces carbonic acid, carburetted
hydrogen, and pure carbon, which is given off in small
flakes. Arsenic was at one time used in the manufacture
of stearine candles to render them hard, and must neces-
sarily have produced injurious results to those inhaling the
fumes of the candles containing it.

Spermaceti gives an excellent light, and evolves no very
injurious substances. The amount of carbon separated is
small.

Tallow gives rise to a great deal of smoke, consisting
principally of carbon in a solid form. A large amount of
empyreumatic oil is also disseminated by its combustion.
Tallow candles give a dull, unpleasant light, and are not
fit to be used in rooms inhabited by the sick. The carbon
and empyreumatic oil produce irritation of the respiratory
passages. A great deal of the unpleasant effects of the
combustion of tallow candles is due to the large size of the
wicks, causing more tallow to be absorbed by them than
can be perfectly consumed; the consequence is that incom-
plete combustion is the result, and the products escape in
the surrounding air.

Parajjine affords an excellent light, and, if kept removed
from currents of air, burns with a steady flame, and gives
off very little smoke.

The animal oils give off, in burning, carbonic acid, car-
buretted hydrogen, and carbon. If the wicks, through
which they are burned, are not well brimmed, or if the
lamps are of a bad model, the amount of these emanations
is very much increased. The vegetable oils, such as those
from rapeseed, linseed, etc., burn with a brighter flame and
give off less carbon. Turpentine, and its combination with
alcohol, though giving a good light, are dangerous, and
their vapor irritating to the respiratory passages ; the same
is true of kerosene and naphtha. Lamps are made which
produce more complete combustion of oils than others, and

LIGHTING OF HOSPITALS. 401

on that account are to be preferred. But, as a general
principle, oils should not be used for lighting hospitals, on
account of their greasy character and consequent liability
to soil things with which they come in contact, and also
because lamps require more care than the other means of
illumination. Turpentine and the mineral oils should
never be employed; they are the most deleterious of all the
several articles which are ordinarily used for producing
light.

The most economical substance for effecting artificial
illumination is gas, both as regards the quantity of light
obtained and the absolute cost. It is also convenient, and
requires no labor, from the attendants of a hospital, in
preparation.

Illuminating gas is composed of carbon and hydrogen, in
variable proportions, according to the character of the sub-
stance from which it is made. As originally produced, gas
is too impure to be burned without injury to those sub-
jected to the influence of the matters given off by it during
its combustion. These matters vary with the nature of
the substance from which the gas is derived. Coal gas
contains carbonic acid, carbonic oxide, sulphuretted hydro-
gen, ammonia, and cyanogen. These are removed in great
part by causing the gas to pass through vessels contain-
ing lime, and sometimes by subjecting it to the action
of other substances. Even, however, when every care
is taken, a small quantity of carbonic oxide, vapor of
bisulphuret of carbon, and ammonia still remain.

Good pure gas when burning does not evolve more dele-
terious matters than candles or oils, but it rarely happens
that a portion of the gas does not escape unconsumed, and it
occasionally happens that the gas is not as pure as it would
be if proper care was always taken at the manufactory to
insure the removal of the noxious substances. Moreover,
when gas is at hand, a flame much larger than that made

402 A TREATISE ON HYGIENE.

by several candles is generally produced, and consequently
the air so much the more contaminated.

Coal gas, as it is ordinarily found, when burned, besides
producing carbonic acid and water, also evolves an acid
vapor, which is sulphurous acid. This is derived from a
small quantity of the vapor of bisulphide of carbon. If
the gas be passed over hydrate of lime, heated to about
600°, the bisulphide of carbon is decomposed, sulphide of
lime is formed, and sulphuretted hydrogen is set free.

The heat produced by gas is an objection to its use,
especially in small rooms ; I have found the flame from a
single burner to raise the temperature of a room, contain-
ing sixteen hundred cubic feet of air, from 55° to 63° in
one hour, and to maintain it at this point for several hours.

In regard to the extent of contamination produced in
the air of houses by the artificial means of illumination
employed, very definite results have been obtained. We
know that combustion takes place at the expense of the
oxygen of the air. Tallow, wax, spermaceti, oil, etc. con-
tain, as an average, about 80 per cent, of carbon and 12
per cent, of hydrogen. In burning, these substances unite
with the oxygen of the atmosphere, producing carbonic
acid and water. In one hour I found a sperm candle burn
away to the extent of 135 grains. In this amount are
contained 108 grains of carbon, absorbing from the atmos-
phere 288 grains of oxygen to form 396 grains of carbonic
acid, equivalent to 841 cubic inches. The room contained
1500 cubic feet of air, and had it been perfectly air-tight,
and the candle had continued to burn for about forty-five
hours, all the oxygen contained in its atmosphere would
have been converted into carbonic acid. Experiment has
shown, however, that air containing as much as ten parts
of carbonic acid in one thousand is not fit to be inspired;
841 cubic inches of carbonic acid were formed in one hour,
and consequently 84,100 cubic inches of air, or 58*4 cubic

LIGHTING OF HOSPITALS. 403

feet, were so far deteriorated as to be unfit for the purposes
of respiration. In twenty-five hours the whole air of the
room would have been rendered injurious to health if re-
spired, even if fresh oxygen had been supposed to take the
place of that uniting with the carbon.

According to Liebig,* an adult man consumes 6000
grains of carbon in twenty-four hours, which is eliminated
from the skin and lungs as carbonic acid gas. Scharling
fixes the amount of carbonic acid formed at 13,438 grains
daily, equivalent to the elimination of 3664*90 grains of
carbon, the balance, 9773*10 grains, being oxygen taken
from the atmosphere. Andral and Gavarret place the
quantity of carbon at 4065 grains, and Carpenter at 3840
grains.

My own experiments-)- are to the effect that about 12,000
grains of carbonic acid are exhaled from the lungs in
twenty-four hours. Of this 8728 consist of oxygen, which
is derived from the air inspired. In addition, over 5000
grains of vapor of water are expired.

We have seen that a candle, in burning one hour, caused
the formation of 396 grains of carbonic acid, equivalent to
9504 grains in the twenty-four hours, or but about 2456
grains less than the amount formed by the respiration of
an adult man during the same period.

Now many candles burn away much faster, and give rise,
in being consumed, to a considerably larger quantity of
carbonic acid, so that it is within the bounds of fact to say
that a candle, while burning, in the main causes as great
a deterioration of the atmosphere as an adult person
breathing in it during a similar length of time.

From the use of oils as illuminating agents, a larger
amount of carbonic acid is formed if the better kind of

* Letters on Chemistry. London, 1854, p. 315.
f Physiological Memoirs, p. 47.

404 A TREATISE ON HYGIENE.

lamps are used, and from coal gas the quantity produced
is still greater.

By accurate measurement I have found that a gas burner
in the room in which I am in the habit of sitting, allows,
when the gas is fully turned on, of the consumption of
4 -25 cubic feet per hour. A cubic foot of coal gas gives
origin, during its combustion, to about 1-25 cubic feet of
carbonic acid, so that for each hour 5 - 31 2 5 cubic feet, or
4322 grains, of carbonic acid are given off to the atmos-
phere of the room. For the twenty-four hours the quan-
tity would amount to 128-50 cubic feet, or 103,728 grains.
It is thus seen that one such burner causes more car-
bonic acid to be formed in a given time than is evolved
from the respiration of eight adult human beings, and con-
sequently causes, so far as the carbonic acid is concerned,
more deterioration of the atmosphere of a room than would
be caused by the presence of eight individuals.

In addition, a large quantity of water is formed by the
union of the hydrogen of the gas with the oxygen con-
tained in the atmosphere of the chamber. Hydrogen is
present in coal gas to the extent of about 23 per cent. A
cubic foot therefore contains by weight 69*23 grains of
hydrogen, and the quantity burned in one hour (4-25 cubic
feet) 294-22 grains. This would unite with 2352 grains
of oxygen (about 4 cubic feet) to form 2646 grains of
water. In a day 96 cubic feet of oxygen would be taken
from the atmosphere and 63,504 grains of water produced.
We see therefore how greatly the atmosphere of an apart-
ment is affected by the combustion from one burner, and
we can of course perceive how vast is the deterioration in
a room where there are several burners from which gas is
consumed. In a ward where there are eight, as there are
in most of the wards of the large hospitals, the deteriora-
tion from carbonic acid would be equal to that produced by
adding sixty-four patients to the complement of the ward.

LIGHTING OF HOSPITALS. 405

Now we have seen that air containing 10 parts in 1000
of carbonic acid is not fitted for the purposes of respiration,
not so much, as has also been shown, from any positively
noxious qualities pertaining to carbonic acid as to the fact
that the presence of this gas is a hinderance to the perfect
oxygenation of the blood. We have also seen that a single
burner in a single hour causes the formation of 53125
cubic feet of carbonic acid gas. We may safely assume
that the gas in a hospital ward is burned for three hours
each day; there would therefore be formed in the course of
a single evening from each burner 15*9375 cubic feet of
carbonic acid, a quantity sufficient to render 1593*75 cubic
feet of air unfit for respiration. Eight burners would
vitiate 12,750 cubic feet of air, or the space that would
ordinarily be occupied by ten patients.

The Mower Hospital at Chestnut Hill, already described,
is lighted by 1050 gas burners. The consumption of gas
in a single month reaches the enormous quantity of 178,260
cubic feet, from which 222,825 cubic feet of carbonic acid
are formed, sufficient to vitiate, so as to render it unfit for
respiration, 22,282,500 cubic feet of air. In a single night
7,427 cubic feet of carbonic acid gas are produced, sufficient
to vitiate 742,700 cubic feet of air. In the absence of posi-
tive data, it may safely be assumed that half the number of
burners in the whole hospital are in the wards, and con-
sequently in a single evening 371,350 cubic feet of air are
so far contaminated as to be seriously detrimental to the
health of those obliged to respire it. The total amount of
space available for patients does not exceed 3,000,000 cubic
feet, so that one-ninth of the whole capacity of the hos-
pital, or the space occupied by about 330 patients, is ren-
dered unfit for them by reason of the vitiation of the air
they are obliged to respire.

It is of course to be understood that these consequences
are based upon the conditions that would result if the con-

406 A TREATISE ON HYGIENE.

taminated atmosphere was suffered to remain in the wards
unchanged. They are merely adduced for the purpose of
showing how very important it is that a sufficiently en-
larged idea of the vitiation caused by artificial illumination
should be formed, in order that adequate means may be
taken for the removal of the noxious products.

It is perfectly possible so to ventilate the gas burners as
not only to cause the products of combustion to be re-
moved, but also to aid in the abstraction of other noxious
matters which are present in the air of inhabited apart-
ments. By the ordinary ridge ventilation this is thoroughly
accomplished so long as the ventilators are left open, as
during the warm seasons of the year; but in winter, when
they are closed, and the system described on page 356, and
represented in Fig. 45, is employed, the gas burners are
not sufficiently ventilated, and hence other means should
be brought into action.

It should undoubtedly be the case that all gas burners
in private houses, and other buildings where people reside
or congregate, should be ventilated. When gas was first
employed it was much more impure than it is now, and
serious objections existed on that account to its introduc-
tion into houses. It was found that a considerable pro-
portion of sulphur was evolved, which, condensing upon
furniture, plate, books, etc., caused a good deal of damage.
Serious injury was sustained by the library of the Athe-
neum Club from this cause.* It therefore became a matter
of importance to remove the noxious vapors, if not for the
preservation of the health of the inmates, at least for the
prevention of injury to their household effects. Sir Michael
Faraday, by an ingenious arrangement, caused a descend-
ing current to carry off the products of the combustion

* Ronalds and Richardson's Chemical Technology, vol. i. part ii. p.
674.

LIGHTING OF HOSPITALS.

407

through a tube leading to the chimney flue. The arrange-
ment was improved by Mr. Kutter, an idea of whose venti-
lating gas burner will be obtained from the accompanying
cut, (Fig. 66.) The burner is shown at a, with a chimney

Fig. 66.

discharging into the metal tube b, which is attached to the
gas pipe c. A glass globe, open only at the top, is sus-
pended by the rim to an attachment to the metal tube b ;
the air enters in the direction of the arrows, feeds the
flame at a, and escapes through the tube b, carrying with
it to a flue the products arising from the combustion of the
gas. The advantages of such an arrangement are at once
seen, for not only are the matters due to the burning of
the gas removed, but a strong current is excited, by which
other impurities are drawn off.

A simpler but less elegant, though equally effectual plan,
is shown in Fig. 67. An ordinary gas burner has imme-
diately above it, at the distance of about three feet, a tin
or iron funnel, into which a tube opens, communicating at
the other end with the chimney of the room. An upward
current is thus established, which not only ventilates the
gas burner, but also aids materially in the removal from
the room of impurities derived from other sources. Such

408

A TREATISE ON HYGIENE.

an arrangement as this should be adapted to every gas
burner in hospital wards. In the temporary military hos-
pitals, instead of passing to the chimney the flue might
proceed directly to the roof, and escape to the exterior at
the ridge. In the winter it would prove no immaterial
means of adding to the ventilation of the ward.

Fig. 67.

From a consideration of the points brought forward rela-
tive to artificial illumination, I trust it will be made suffi-
ciently apparent that it is almost as necessary to get rid of
the products of the combustion of the illuminating material
as of the exhalations from the bodies of the patients who
may be in the wards of a hospital. If we regard alone the
carbonic acid and vapor of water which are formed, there
is a much greater reason for ventilation, as the products
are so much larger; but as the human body throws off a
quantity of organic matter which, as has already been
shown, is far more injurious in its action than carbonic
acid, the necessity for general ventilation is still more im-
perative. The principles by which it is to be accom-
plished will be indicated in their more striking features
in a following chapter.

HEATING OF HOSPITALS. 409

CHAPTER XVII.

HEATING OF HOSPITALS.

In artificially heating buildings the same difficulties are
to be met as in producing artificial illumination, unless the
air is warmed in the manner to be described, by radiation
from or contact with pipes containing steam or hot water.

The substances which are used to produce heat must
contain a large amount of carbon and hydrogen in order to
be economical, these being the matters which, by their com-
bustion, cause the greatest evolution of caloric. These sub-
stances are known as fuel, and are of vegetable or animal
origin. Those of the firsi>named class are wood, peat or
turf, lignite, bituminous and anthracite coal, wood-charcoal,
peat-charcoal, coke — or the charcoal from coal — alcohol,
ether, and vegetable oils. All of these, except the three
last, are essentially woody fiber, and, with the exception
of the first named, have been changed by natural or arti-
ficial causes to the condition in which they are found.
Thus peat is produced from the long-continued action
of water on vegetable matters, whereby they are con-
verted into a soft soap-like mass of a black color; lig-
nite is fossil wood of a comparatively early formation;
bituminous coal is still older, and contains more carbon;
and anthracite is the oldest of all, and is harder than the
former, from which it chiefly differs in the fact that the pro-
cess of carbonization is further advanced than in the others.
It ignites with difficulty, and only in a strong current of
air, burning without the evolution of smoke. The follow-
ing table exhibits the composition of several kinds of coal :

410

A TREATISE ON HYGIENE.

Newcastle.

Staffordshire.

Wigan cannel.

Anthracite.

Carbon

81-41
5-83
7-89
2-05
0-75
2-07

78-57
5-23

12-88
1-84
0-89
1-03

80-07
5-53
8-09
212
1-50
2-70

90 89
3-28
2-97
0-83
0-91
1-61

Hydrogen

Sulphur

Ash

1-276

1-278

1-276

1-392

Approximate formulae...

C 27 H u 2

^26"l0^3

^26"lo"2

C 40 H 8 O.

From this table an idea can be formed of the character
of the matters given off by the combustion of coal, and the
necessity for removing the gaseous products which result
from its oxidation.^

Coke is produced from coal being heated, with depri-
vation of air, to such an extent as to drive off the vola-
tile matters, leaving behind a porous substance, consisting
of carbon and earthy substances, which is the coke. The
several kinds of charcoal are formed by burning wood or
peat in confined spaces. As with coal, the volatile pro-
ducts are separated, and the charcoal remains. Alcohol
and vegetable oils have but a limited application as pro-
ducers of heat, and ether is still less used.

The animal oils and fats are occasionally used for heat-
ing purposes, but their employment in this direction is not
extensive.

Illuminating gases are also used as fuel, especially in
connection with the arts and sciences.

The substances known as artificial fuel scarcely deserve
the name, as they consist of saw-dust, coal-dust, etc. ce-
mented with tar or bitumen.

All kinds of fuel do not, in burning, evolve like quanti-
ties of heat. The differences to be observed in this respect
are very striking, and are shown in the following table,
which indicates the quantity of water which one pound of

HEATING OF HOSPITALS. 411

each of the substances specified will raise from 0° to 100°
centigrade, or from 32° to 212° Fahrenheit.

Hydrogen 236

Pure carbon 78

Wood charcoal 75

Dry wood 36

Wood containing 20 per cent, of water 27

Good coal 60

Peat 25 to 30

Alcohol 67

Ether 80

Vegetable oil, rape oil, wax, etc 95

Hydrogen, therefore, is pre-eminent as a heat-producing
substance, and a fuel is valuable in proportion to the
amount of this element entering into its composition.

So far as the hygienic value is concerned, the case is dif-
ferent as regards the compound substances. Hydrogen, in
burning, gives rise to no other substance than water, and
consequently it would be, as it is the best heat producer,
also the most valuable in a sanitary point of view; but pure
hydrogen is, on many practical accounts, inadmissible for
the ordinary purpose of fuel, and compound bodies in
which it exists in greatest quantity have associated with it
other substances which, in the process of combustion, give
origin to vapors and gases which are highly deleterious in
their character. Thus the various kinds of coal contain
sulphur, from which sulphurous acid and sulphuretted hy-
drogen are formed— both in the highest degree prejudicial
to health. Nitrogen is present, which, uniting with hydro-
gen, gives origin to ammonia, which is extremely irritating
to the respiratory passages. A portion of the carbon unites
with a portion of the nitrogen and hydrogen, and hydro-
cyanic acid is produced, not in large quantity, but yet in
sufficient amount, if not removed, to cause very consider-
able disturbance in the healthy working of the organism.
The rest of the carbon, which is consumed, unites with the

412 A TREATISE ON HYGIENE.

oxygen of the air to form carbonic acid and carbonic oxide,
the latter a substance extremely poisonous in its action on
the system when inhaled into the lungs ; but from bitumi-
nous coal a considerable amount escapes unconsumed in
the form of smoke, which consists of small particles of pure
carbon. In many places where large quantities of bitumi-
nous coal are burned, the smoke is a source of much dis-
comfort. Coke, during combustion, yields sulphurous acid,
carbonic acid, and carbonic oxide; and charcoal also gives
rise to the two last-named substances while burning. The
many suicides and accidental deaths which have been
caused by burning charcoal have been due to the inhala-
tion of the carbonic oxide evolved during the process.
Wood, when burned, gives off a large quantity of carbon
in the form of smoke, the vapor of water, empyreumatic
oils, carbonic acid, and carbonic oxide. The irritating
qualities of wood smoke are due to these empyreumatic
substances, among which creosote is the chief.

Now in order to obtain heat from fuel, without at the
same time subjecting ourselves to the action of the noxious
substances mentioned, various contrivances have been de-
vised which, with more or less completeness, allow of the
removal of the deleterious matters, or which are placed at a
distance from the apartments to be warmed, and heat them
through the medium of water, steam, or by currents of
hot air. These are open fire-places, stoves, furnaces sup-
plying hot air, steam apparatus, and hot water apparatus.

The open fire-place is, on several accounts, to be preferred
to any other means of heating an apartment. It insures,
when well constructed, the removal of those products of
combustion which tend to vitiate the atmosphere, and at
the same time causes a strong current of air to pass from
the room through the chimney, by which alone tolerably
effective ventilation is produced.

But it has certain objectionable features which preclude

HEATING OF HOSPITALS. 413

its employment when a steady and uniform heat is re-
quired, and when it is especially desirable to avoid irregu-
lar currents of air. It is therefore not adapted for use in
large rooms, such as hospital wards, where many sick per-
sons are present. If wood is the fuel used, the frequent
necessity of replenishing the fire, the lowering of tempera-
ture which ensues if there is the least neglect in attending
to this point, and the great loss of heat through the chim-
ney afford almost insuperable reasons against the open fire-
place during the colder months of the year. If coal is
burned, although there is more heat, yet it is impossible to
avoid the exhalation of a portion of the deleterious gases and
vapors throughout the chamber; and the dust, in the form
of ashes, which is profusely scattered, adds seriously to the
inconvenience and unhealthiness. In addition, the warmth
from a fire-place is not generally diffused throughout the
room. The heat is almost entirely communicated by
direct radiation, and consequently while that part of the
body turned toward the fire is heated perhaps to excess,
the portions not exposed to the rays of heat are not suffi-
ciently warmed.

On the other hand again, the cheerfulness imparted to
the mind by the sight of an open fire should not be over-
looked, and the influence of the light emitted is also an
important element in the consideration of the subject; so
that while, as has been said, the objections applicable to
the use of open fire-places in large rooms, especially those
inhabited by sick persons, are almost insurmountable, the
advantages from them will always cause their employment
in smaller rooms, inhabited but by one or two persons, and
in cases where economy is no object. When used, wood is
to be preferred, and next, good bituminous coal. The gases
evolved from anthracite, coke, and charcoal are much more
deleterious, and, as has been said, a portion will unavoid-
ably escape into the air of the room. There are many

414 A TREATISE ON" HYGIENE.

persons who cannot endure an anthracite or coke fire in
an open fire-place without headache or bronchial irritation
being the inevitable consequence.

Staves are of so many different patterns that to describe
them all, or even a tithe of them, would require more space
than could profitably be devoted to their consideration.
There are certain general features which are attached to
all stoves without reference to the material of which they
may be constructed, or the peculiar pattern after which
they are formed.

Stoves not only heat the atmosphere by radiation but
also by conduction, and hence any organic matters which
may be suspended in the air are volatilized on coming
in contact with the heated metal. In an open fire-place a
great portion of the heat, amounting generally to as much
as 90 per cent., is drawn up the chimney, but that given
off from a stove is retained in the room to a much greater
extent.

A serious objection to stoves is, that as the air surround-
ing them becomes heated and specifically lighter, it ascends
to the ceiling, and therefore the lower strata of air con-
tained in a room heated by a stove are never so hot as the
upper.

Another objection arises from the dryness of the atmos-
phere which is produced by the heat of a stove. It is cus-
tomary to have a vessel on top of the stove containing
water, by the evaporation of which this evil is partially
obviated, but it is not altogether got rid of, and the
arrangement requires attention which is seldom given
to it.

Stoves in which coal is burned always allow the escape
into the apartment of a portion of the gases and vapors
given off during combustion. If wood is the fuel, this
source of vitiation is not so great, as the gases which arise
from the burning of wood are lighter than those from coal,

HEATING OF HOSPITALS. 415

and consequently there is a greater tendency for them to
escape through the pipe. Moreover, coal always contains
mineral substances, such as sulphur, which, being vola-
tilized, are diffused more or less completely, in the form of
vapor, throughout the room. On this account coal stoves
are exceedingly unfit for rooms in which invalids are con-
fined, but, as they are economical and require little atten-
tion, they are used in the temporary military hospitals of
the country. The civil hospitals, without, so far as I know,
an exception, are heated by more improved methods.

Furnaces placed at a distance from the apartments to
be heated, generally under them, are modifications of the
ordinary stove, differing only in the fact that air is brought
to the stove, heated by conduction, and then allowed to
ascend to the rooms through pipes or flues. If proper pre-
cautions are taken to insure a full supply of fresh air from
the outside, to prevent the mixture of the gases from the
fuel with the hot air, and to provide sufficient moisture,
this method of warming is not very objectionable. It,
however, almost invariably happens that proper measures
are not taken to insure these ends, and consequently the
air of apartments heated by subterranean furnaces is almost
always oppressive. It is only necessary to allow a piece of
polished silver to stand for a few days in a room warmed
in this manner to be convinced of the presence of the
vapor of sulphur in the atmosphere, as the silver very
rapidly becomes tarnished by the formation of the sul-
phuret. I have also caused the warmed air to pass
through Liebig's potash-bulbs, and have always found an
excessive amount of carbonic acid to be present. And yet
I have seen educated persons, or those who from their
position in life ought to have known better, crowd them-
selves, to the number of five or six, into a room scarcely
fifteen feet square, in which there was no window, in which
two gas burners were lighted, and with the doors shut,

416 A TREATISE ON HYGIENE.

crouch over a flue from a red-hot furnace, through which
air hot enough to parch the skin was being discharged
with horrible rapidity. Should it be a subject for surprise
that such persons were annoyed with coldness of the ex-
tremities, and were haggard and ghastly looking in the
morning, and that they were afflicted with almost constant
headaches, dyspepsia, and other affections evincing dis-
order of the organism? As used in this country, hot-air
furnaces, I have no hesitation in saying, are productive of
more disease and discomfort than are caused by all the
other means of producing artificial heat combined.

Buildings are sometimes heated by steam, which, by
some, is considered to possess advantages over hot water
used in a similar manner. A boiler is fitted up in some
convenient place, and the steam is either conveyed in pipes
directty to the rooms to be heated, or hot air is caused to
come in contact with coils of pipes containing steam, and
then admitted to the apartments.

The chief disadvantage of steam as a heating agent con-
sists in the fact that it is difficult to regulate the tempera-
ture. The pipes must be kept at 212° Fahrenheit, or con-
densation of the vapor at once takes place and water is
formed. In passing from a state of vapor to that of a liquid,
steam parts with its latent heat, which becomes sensible,
and thus the temperature of the pipes is raised. The latent
heat of steam being 1000°, a great source of heat is thus at
command; but if the pipes are allowed to cool again below
212°, a fresh portion of steam is condensed, and so on till
the whole of it has been converted into water and has
parted with all its latent heat. It now occupies but tsW
part of the space as water which it did as steam, and con-
sequently has a heating power equivalent to that of an
equal bulk of water. Bulk for bulk, the heating power of
steam compared to that of water is as 1 to 288 — that is, a
cubic foot of water will give out 288 times as much heat

HEATING OF HOSPITALS. 417

as a cubic foot of steam in passing from 212° to 60°.
Bringing into consideration other factors, such as the spe-
cific heat of the iron of which the pipes are made, the heat
from the water contained in the boiler, and of the brick-
work around the boiler, it is found that a building warmed
with hot water will maintain its temperature, after the fire
is extinguished, about six or eight times as long as it
would do if it were heated with steam.*

The air warmed by steam is not baked, as is that which
comes in contact with the heated surface of a stove, and
hence is not deprived, to an equal extent, of its moisture.
It is therefore less irritating to the lungs, and being abso-
lutely uncontaminated by the vapors and gases given off
by the burning fuel, is altogether preferable to any direct
means of heating.

There are many forms of steam heating apparatus in
use, some of which are preferable to others. The subject
in these relations will be best studied from the works
specially devoted to the consideration of the principles of
artificial heating.

' Hot water affords another excellent means for obtaining
artificial warmth, and the principles upon which the pro-
cess is conducted do not differ essentially from those which
govern that last described. Pipes are arranged in connec-
tion with a boiler containing water. Heat being applied,
those particles of the water nearest to the source of the
heat first become warmed, and at the same time specifically
lighter. They consequently rise to the top of the boiler
and enter the pipe, which conveys them throughout the
building to be warmed. If this water were allowed to
escape, there would be a constant necessity for replenishing
the boiler; but after it has lost a portion of its heat it is

* A Practical Treatise on Warming Buildings by Hot Water, etc.,
by Charles Hood, F.R.S., etc. London, p. 61.

418

A TREATISE ON HYGIENE.

returned to the boiler, and the process is repeated. An
idea of the arrangement will be obtained from the accom-
panying cut, (Fig. 68,) in which a indicates the boiler, b

the mouth of the tube through
which the hot water is distrib-
uted, c c the tube as it ramifies
through the building, inclining,
after it has passed a certain
point, toward the boiler, and
emptying into it at d; at e a
tube is shown by which the air
is allowed to escape from the
water.

The pipes may be arranged
in coils, contained in boxes
under the floor, communicating
with the external atmosphere.
A register in the wall or floor
allows the hot air to enter the
chamber.

Hot water has almost entirely
superseded steam as a heating
agent. Its effects are more uni-
form, and it is also more economical. The first employ-
ment of this means is usually ascribed to M. Bonnemain,
who made use of it in 1777, in an apparatus for hatching
chickens,* but Tomlinson-)- assigns the credit to Sir Martin
Triewald, a Swede, who, in the year 1716, warmed a green-
house by hot water. The water was boiled outside the
building, and then conducted by a pipe into a chamber
under the plants. Water was heated for the baths of the

* A Practical Treatise on Warming, etc., by Charles Hood, F.R.S.,
p. 4. Reid on Ventilation, etc., p. 242.

f A Rudimentary Treatise on Warming and Ventilation. London,
1850, p. 131.

HEATING OF HOSPITALS. 419

ancient Romans by passing it in coils of pipes through fire,
but this was not for the purpose of communicating warmth
to the atmosphere.

It is highly probable that warm water was in use for
heating the air of houses long before any experiments on
the subject by Triewald or Bonnemain, and I have been
able to find a reference to it which fixes its use at a much
earlier date. In a work published in 1745,* to wfeich
reference has already been made, it is stated that a certain
Danish sea captain, by name Jacob Hall, met at Iceland a
monk who, in the year 1546, lived in Greenland, and who,
among many other things, told him "that in the convent
of St. Thomas, (in Greenland,) where he had passed much
time, there was a well of burning hot water, which, through
pipes, was conveyed into all the rooms and cells of the
convent for to warm them." It is also affirmed that
" Nicholas Zenetur, a Venetian by birth, who served the
King of Denmark in the quality of a sea captain, is said
by chance to have been driven upon the coast of Green-
land in the year 1380, and to have seen that same Domini-
can convent. His relation is abridged by Kircherus in
the following words : ' Here is also a Dominican convent
to be seen, dedicated to St. Thomas, in whose neighbor-
hood there is a volcano of a mountain that spews fire, and
at the foot thereof a well of burning hot water. This hot
water is not only conveyed by pipes into the convent and
through all the cells of the friars to keep them warm, as
with us the rooms are heated by stoves of wood fire or
other fuel, but here they also boil and bake their meat and
bread with the same.' "

It is only within the last twenty-five or thirty years

* A Description of Greenland, showfng the Natural History, Situa-
tion, etc., by Mr. Hans Egede, Missionary in that country for twenty
years. Translated from the Danish, p. 20.

420 A TREATISE ON HYGIENE.

that hot water has been much used for heating buildings,
and it is not yet employed to as great an extent as its
merits warrant. Hygienically there is nothing, beyond
the fact that hot water parts with its heat less rapidly
than steam, that makes it preferable to this last-named
agent, but this one circumstance renders it more generally
applicable for heating hospitals. One or the other should
always be used; the objections to open fire-places, stoves,
and hot>air furnaces have already been mentioned: they
are of such a character as renders them unfit to be used in
rooms intended for the reception of many sick persons.
The hot water apparatus also admits of any degree of heat
between 212° and the temperature of the atmosphere be-
ing obtained, and on this account its advantages are very
decided.

Many forms of apparatus are in use for heating by means
of hot water. All require to be carefully adjusted; but as
the subject is now thoroughly understood, little difficulty
is experienced on this account. Most of the hospitals of
Great Britain, France, and the United States are warmed
with either hot water or steam. Any other means should,
as we have said, be condemned, and can only be tolerated
when it is impossible to obtain either of those cited.

One of the principal duties which medical officers in
charge of hospitals have to perform is the regulation of the
temperature of their wards. The stoves which are in use
in the temporary general hospitals scarcely admit in very
cold weather of obtaining a satisfactory and uniform heat
in a ward. In the vicinity of the stove the temperature
will be greater than is necessary, while at the distance of a
few feet it is much less than is proper. A uniform tem-
perature is highly desirable, and it should, in winter, be
from 60° to 62° of Fahrenheit. At night it may be
allowed to fall as low as 50°, but should never reach that
of the external atmosphere, or even to 35°. No other

VENTILATION OF HOSPITALS. 421

means than hot water or steam will permit of uniformity
of temperature or of regulation at will.

Other means of heating, such as by gas, artificial fuel,
etc., we pass over as not at all applicable to hospitals. It
is more than possible, however, that stoves for burning gas
will eventually be constructed which will fulfil every indi-
cation, but at present they are far from being fit for the
purpose, and are in the highest degree injurious to the
health of those using them. A gas grate which is used in
England, and which consists of a coil of gas pipe perforated
by numerous small holes, is the best apparatus I have seen
for burning gas as fuel. Pieces of asbestos are thrown
over the pipe, and these, becoming incandescent, give the
fire very much the appearance of that produced by live
coals.

CHAPTER XVIII.

VENTILATION OF HOSPITALS.

We have already made many allusions to ventilation,
and have described the ridge ventilation in use in the tem-
porary military hospitals, and the substitute for it, to be
employed during the winter months. The necessity for
efficient ventilation has also been pointed out; and the dele-
terious consequences of inspiring air which has been con-
taminated by the respiration of many persons, by the ema-
nations from sewers and cess-pools, and by the means used
to produce artificial illumination and warmth have like-
wise been considered to some extent. It is expedient,
however, that these points should be still further dwelt
upon, in order that certain subjects may receive more at-
tention than could be given to them under other heads,

422 A TREATISE ON HYGIENE.

and to bring forward certain facts which, for the same
reason, could not otherwise be adduced.

Confined air, under all circumstances, is injurious if in-
haled into the lungs. Though it may not have been
vitiated by respiration, by combustion, or by emanations
from known sources of contamination, the mere fact of its
having been stagnant is sufficient proof of its unwhole-
someness. It is very much with air as with water ; it re-
quires to be kept in motion to be retained in a condition
fit to enter the system.

On entering a room which has been kept closed for some
time a peculiar and characteristic odor is perceived. This
fact of itself is evidence against the insalubrity of the air
for it may be laid down as a law, admitting of very few
exceptions, that air which is capable of making an impres-
sion on the sense of smell is not suitable for the purposes
of respiration.

Now what can communicate an odor to air which has
been subjected to none of the ordinary and recognized
causes of vitiation, but which has simply been retained in
a closed chamber? The matter is a very simple one. The
air of such a chamber always contains organic substances,
animal and vegetable. The emanations from the last oc-
cupant, the fibers from carpets, blankets, curtains, linen,
etc., the vapors which are given off from the varnish and
paint of the furniture and other wood-work, and from the
wood itself, and the various substances, such as spores,
starch, etc., which find entrance into any place not abso-
lutely air tight, are all there and undergoing decomposi-
tion. Stagnant air therefore presents another point of
analogy to stagnant water; it contains animal and vege-
table bodies which are undergoing decomposition. The
subject admits of positive experimental illustration.

I placed an exhausting apparatus, connected with a set
of Liebig's bulbs, containing a standard solution of perman-

VENTILATION OF HOSPITALS. 423

ganate of potassa, in a room which had been immediately
before thoroughly aired. The apparatus was set in action,
and it was found that it required 1085 cubic inches of air
to pass through the solution in order to decolorize it. In
my office, which is a large room, well ventilated, and in
which only one person is generally present, 979 cubic
inches of air decolorized the solution. The air of the first-
named room was therefore freer from organic matter than
the last.

The windows and doors of the room were now closed,*
and it was not entered or opened for ten days. At the
end of that time the apparatus above described was intro-
duced and put in operation. It was now found that 725
cubic inches of the air were sufficient to effect a complete
decolorization of the solution of permanganate of potassa,
and consequently more organic matter was present in the
atmosphere of the room than ten days previously after
complete ventilation.

At the same time experiments were conducted relative
to the proportion of carbonic acid present, a similar ar-
rangement — the potash-bulbs containing a solution of
caustic potassa — being used, and chloride of calcium tubes
being added to the apparatus to absorb the moisture of the
air before passing through the potash solution. On the
first occasion it was found that 10,000 cubic inches of air
contained 3 - 5 cubic inches of carbonic acid. On the second,
after the room had been closed for ten days, the carbonic
acid had become increased to 3 - 9 cubic inches in 10,000 of
air.

We have thus a ready explanation of the cause of the
odor and of the unhealthy character of air which has been
so conditioned as to have become stagnated. We see
therefore that one of the most essential conditions of the
fitness of air for respiration is that it shall be kept in
motion, and hence if there were no more positive and

424 A TREATISE ON HYGIENE.

potential causes of vitiation than those mentioned as act-
ing upon the air of a close room, the necessity for ventila-
tion would be still very great.

"When, however, in addition to stagnation or insufficient
motion are added the many causes of contamination which
result from animal life and the various artificial processes
connected with it, the need of change in the atmosphere of
an apartment becomes much more imperative, and cannot
be resisted without danger not only to health but to life.
* We have already seen how injurious to life are the ema-
nations from the animal body, and how important it is for
the comfort and existence of the sick that an ample allow-
ance of air should be supplied to them. We have now
again to draw special attention to the subject and to point
out the absolute necessity of frequently renewing the air
which is to be taken into the system to aid in maintaining
the proper working of the functions of the organism.

We have seen that the essential constituent of the at-
mosphere, so far as the process of respiration is concerned,
is oxygen, and that anything which interferes with the
supply of the proper amount of this element is a source of
discomfort if not of disease. We have also seen that the
process of respiration causes an absorption of oxygen and
the substitution of carbonic acid and water for it, and that
in addition there are organic emanations from the skin and
lungs, the action of which, when again caused to enter the
system through the lungs, is positively fatal if the process
is carried on even for a comparatively short period.

I have already expressed the opinion that a proportion
of carbonic acid, not exceeding ten parts in one thousand
of air, is injurious to the health of those breathing such an
atmosphere. There can be no doubt that such is the case,
but there is reason to believe that a proportion much less
than this will produce effects detrimental to the well-being
of the organism. An individual placed suddenly in an at-

VENTILATION OF HOSPITALS. 425

mosphere of pure carbonic acid gas would die with the
same symptoms and from essentially the same cause as if a
cord had been tightly tied around his trachea. The en-
trance of atmospheric air to his lungs would be in both
cases effectually prevented, not, as we have seen, from the
absorption, in the first case cited, of any portion of the car-
bonic acid, but from the fact which would equally exist in
the second, that no oxygen would reach the lungs. What
is true of a whole is true of a part, and we may therefore
assume with certainty that the smallest possible proportion
of carbonic acid in the atmosphere renders in some measure
that atmosphere unfit for respiration. The effect may be
so small as to be inappreciable at once, but it is there, and
if the cause is continued, the result will inevitably show
itself.

It is rarely the case that the wards of a hospital can, by
any system of ventilation, be so freed from carbonic acid,
aqueous vapor, and organic emanations that the contained
atmosphere will be identical in composition with that of
the outside of the building. It is altogether too much to
expect this. If such a condition could be brought about,
hospitals would be removed from the operation of that
cause which of all others is pre-eminent in rendering them
insalubrious. But though we cannot obtain perfection of
ventilation, we can adopt means which are so efficacious, in
removing the excreta from the skin and lungs from inclo-
sures, that the injury they can produce is reduced to an
amount extremely small.

No duty is more imperative upon those having charge of
hospitals than that of doing all in their power to insure, as
nearly as possible, complete ventilation of the wards under
their charge. I have inspected hospitals where no atten-
tion whatever was paid to this point, where the fact that
dozens of patients affected with typhoid fever, dysentery,
and other zymotic diseases were breathing over and over

426 A TREATISE ON HYGIENE.

again the same air, was either unnoticed by the medical
officers or uncared for. They could complain that some
refined medical preparation for which they had asked was
not forthcoming, but their own criminal neglect of the first
of nature's laws, their ignorant or wilful disregard of the
lives of those so unfortunate as to be committed to their
care, was of far less importance in their estimation than
an alleged deficiency of certain drugs. No better test of
the professional fitness of a physician or surgeon to take
the charge of a hospital can be found than the estimate
which he puts upon the importance of providing an abund-
ance of fresh air for his patients.

I have recently examined the wards of several military
hospitals. With one or two exceptions all were in good
condition, and especially so as regarded ventilation. The
ridges were open, and an abundance of fresh air entered
through the openings in the sides of the wards. The
amount of cubic space varied from 900 to 1100 cubic feet,
which, in temporary pavilion hospitals, is an ample allow-
ance. Nevertheless, in those which were in the best order
the amount of carbonic acid present was 0'68 in 1000
volumes of the contained atmosphere, while outside it was
but 037 per 1000. In the hospital in which the least at-
tention was paid to ventilation the proportion was 2*11
parts to 1000 of air. Even this last result is better than
some of those obtained by Leblanc,* who, in one of the
wards of the Salpetriere, found 8 parts in 1000 of air by
weight, or 5'33 parts by volume. Ramon de Luna,f in
one of the wards of the Princess's Hospital of Madrid, de-
tected 30 parts of carbonic acid in 1000 of air by volume,
and in the General Hospital as much as 4*3 parts.

With regard to the amount of organic matter present,

* Annales de Chimie et de Physique, 1842, tome v. p. 260.
f Annales d'Hygiene, 1861, tome xv. p. 361.

VENTILATION OF HOSPITALS. 427

ray observations led only to comparative results, but they
accorded very closely with those relating to the proportion
of carbonic acid present. A solution of permanganate of
potassa — which was decolorized in the open air only after
1353 cubic inches of air had passed through the arrange-
ment — was, in the hospital which contained the least
amount of carbonic acid gas in the atmosphere, decolorized
by 801 cubic inches, and in that which contained the most
by 617 cubic inches.

Hospitals have always been recognized as in themselves
great causes of disease unless unremitting care is taken to
provide means for continually changing the atmosphere of
their wards. Even with every effort dictated by the most
thorough acquaintance with the science of hygiene, and the
most conscientious endeavors to discharge faithfully the
duties of his office, the medical officer of a hospital will
sometimes find diseases originate under his eyes which can
only owe their source to infection. When there is perfect
ventilation there is no infection. Contagion can only act
in confined air. Erysipelas, pyemia, hospital gangrene,
typhus and typhoid fevers are diseases which are almost
unknown among individuals not exposed to the dangers
resulting from overcrowding and want of fresh air; and the
best means of lessening their malignancy and of prevent-
ing their spreading is separation of those among whom they
exist or who are subject to the effluvia by which they are
caused. M. Larrey,* in calling attention to this subject,
says : —

"The danger of infection depends upon the vitiation of
the atmosphere, especially during the night. The natural
excretions of the sick — the breath, the fetid perspiration,
the expectorated matter, the intestinal and urinary evacua-
tions, the suppurations from wounds and ulcers, and some-

* Notice surles Hopitaux Militaires, etc. Paris, 1862, p. 28.

428 A TREATISE ON HYGIENE.

times the putridity of mortification or of hospital gangrene
— are so many sources or foci of contamination, without
counting the odors of medicines, of tisans and poultices, the
evaporations from liquids, the emanations from the soil,
from the oil or gas used for illumination, from the bed
linen, and from the too closely situated or badly constructed
latrines."

Levy* is equally emphatic: —

" I repeat what I have said before, that I am far from
denying the importance of diet, of curative methods, of
careful attention, of an efficient administration, etc., but all
these elements of hospital service are secondary to the
necessity for having pure air. Bring them to the highest
degree of ideal perfection, and if the air is vitiated, or if it
is insufficient in quantity, neither improvement is mani-
fested nor the mortality lessened."

The instance of the prisoners confined in the Black Hole
at Calcutta has already been adduced as affording an ex-
ample of the effects of a vitiated atmosphere ; others were
brought forward as being caused by overcrowding in
prisons ; and it would be very easy to cite many more, all
showing the deplorable results of deficient space and ven-
tilation. The instances which occurred at St. Cloud are
too striking to be overlooked, and should be a warning
against the crowding of soldiers. The king was in the
habit of spending a portion of the year at the palace, and
it was remarked that invariably about a week after his
arrival the garrison was attacked with a malignant epi-
demic of typhoid fever. The inhabitants of the town
always escaped ; it was confined altogether to the privates,
the non-commissioned officers being unaffected. Attention
being at last forcibly directed to the matter, it was not

* Sur la Salubrite des Hopitaux en Temps de Paix et en Temps de
Guerre. Paris, 1862, p. 12.

VENTILATION OP HOSPITALS. 429

difficult to ascertain the cause. The ordinary garrison
consisted of about 500 men, who occupied barracks suffi-
ciently large for their accommodation ; but when the king
came, the force was increased to over 1200 men, the addi-
tional number being crowded into the rooms previously
occupied by but 500. The consequences were invariable,
for no one, not even kings, can violate the laws of hygiene
with impunity. The non-commissioned officers had ample
space, and hence their immunity.

The Crimean war afforded many examples of the con-
sequences following a disregard of the first principles of
hygiene. In both the English and French armies the evil
of bad ventilation, or rather no ventilation at all, was per-
haps the greatest cause of the frightful suffering and mor-
tality which prevailed in the allied forces. It can scarcely
fail to impress upon army medical officers the importance
of the most thorough attention being given to this subject
if a few instances of the conditions under which the sick of
these armies suffered are brought forward.

The Commission* dispatched to the seat of war by the
British Government, in speaking of the Barrack Hospital at
Scutari, state that the first thing that attracted their atten-
tion on entering the hospital was the defective state of the
ventilation.

"Excepting a few small openings here and there, there
were no means of renewing the atmosphere within the hos-
pital. The large cubic space above the top of the ward
windows always retained a considerable amount of hot and
foul air, for which there was no escape. There was not
even an open fire-place connected with the building, and
the wards were heated by stoves, the pipes of which passed
through a small hole at the top of one of the windows.

* Report to the Right Hon. Lord Panmure, Gr.C.B., etc., Minister at
War, of the Proceedings of the Sanitary Commission dispatched to the
Seat of War in the East, 1855-56. London, p. 12.

430 A TREATISE ON HYGIENE.

" There was no communication between the wards and
corridors in the majority of instances, except by the doors,
and hence that free circulation and perflation of the atmos-
phere, so necessary in military hospitals, was impossible.

" The wards and corridors being both occupied by sick,
they could in fact be considered only as two hospitals built
back to back, with the foul air in each intermingling by
the doors.

"The effluvia from the privies had free access to the
corridors, and added materially to the impurity of the air."

Similar remarks are made of nearly all the other hos-
pitals.

Miss Nightingale,* in referring to the hospital at Scutari,
says that —

"With regard to the ventilation, scarcely anything had
been done, up to the arrival of the Sanitary Commission,
March 6th, 1855, to improve its state in the Barrack Hos-
pital, not even as much as breaking a pane of glass in the
privies.

" What they did, show its defects ; and what the atmos-
phere was at night in that hospital, especially in corridor
and wards, it is impossible to describe or to remember,
without wondering that every patient in them was not
swept off by fever or cholera."

M. Baudensf ascribes the terrible epidemic of typhus
fever, which prevailed among the troops in the Crimea, to
the impossibility of isolating those attacked and of obviating
overcrowding.

JacquotJ says there is no typhus in summer, for then the
soldier lives in the open air and in open barracks and tents.

* Notes on Matters affecting the Health, Efficiency, and Hospital
Administration of the British Army, etc. Presented by Request to the
Secretary of State for War. London, 1858, p. 87.

f Le Guerre de Crimee, etc., p. 244.

X Du Typhus de l'Armee d'Orient. Paris, 1858, p. 65.

VENTILATION OF HOSPITALS. 431

According to this author, in 1856 a part of the French army
lived in huts insufficiently ventilated. After the fatigues
of the trenches, wet often with rain or snow, the soldiers
would return to their tents, close every opening, light what
fire they could, and then swelter in the vitiated atmosphere
produced by the smoke of tobacco, the evaporation from
their wet garments, and their own fetid exhalations. Is it
any wonder that typhus broke out among them?

Cazalas* ascribes this typhus epidemic entirely to the
aggregation of men, and to consequent concentration of the
effluvia from their bodies, with deficient ventilation.

In our own service, though it must be confessed that suf-
ficient attention to ventilation has not always been given
by those having the charge of hospitals, nothing equaling,
in this respect, the deplorable condition of the allied
armies, has existed, except in one or two isolated in-
stances. The hospitals which I inspected at Grafton and
Cumberland, in the spring of 1862, were as badly managed,
in regard to ventilation, as any which were in operation in
the Criuiea; in fact, nothing could have been worse than
some of these so-called hospitals. In my report-)- I stated,
in referring to one of these buildings, in which the ventila-
tion was entirely disregarded, the police bad, and in which
the inmates had but 229 cubic feet of space each, that such
a condition of affairs did not exist in any other hospital in
the civilized world; and that it was altogether worse than
any which were such opprobria to the Allies during the
Crimean war. One room in another hospital contained
1440 cubic feet of space, and had nine patients in it.

In extenuation of such a condition, it is to be recollected
that the army corps to which the sick belonged had moved,

* Maladies de l'Armee d'Orient, etc. Appendix, p. 15.
t Two Reports on the Condition of the Military Hospitals at Grafton,
Ya., and Cumberland, Md. Published by permission.

432 A TREATISE ON HYGIENE.

leaving all the disabled behind them, and that overcrowd-
ing was unavoidable. Prompt measures were taken for
remedying the evil.

At Grafton a regiment had been encamped, in which the
sickness was such as to attract the attention of the general
commanding the department. Here a room was found con-
taining 672 cubic feet, and tenanted by eight men afflicted
with measles. There were but two windows, and they
were closed. Other rooms were not in a much better con-
dition. Proper sanitary measures were immediately taken,
and the amount of sickness was at once reduced.

In the civil hospitals of the world instances have not
been wanting of the effects due to deficient ventilation.
The case of the ward in the City Hospital of New York
has been cited. Another instance is almost as striking.
The Beaujon Hospital of Paris is situated in one of the
most healthy quarters of the city. It consists of four pavil-
ions, identical in size and in the character of diseases re-
ceived into them. Three of these pavilions were infected
with the poison of erysipelas and hospital gangrene ; the
other was altogether free from it. These conditions had
lasted for a long time.

To what cause was this immunity to be ascribed which
had continued so many months ? The three contaminated
pavilions had no ventilation ; while in the other, which had
remained free from the infection, each patient was supplied
with 50 cubic metres of fresh air per hour. Boudin* attrib-
uted the existence of these diseases in the one case, and
their absence in the other, solely to the state of the venti-
lation; and there can scarcely be a doubt of the correctness
of his conclusions.

In earlier times, the absence of ventilation and the over-

* De la Circulation de l'Eau considered comme moyen de Chauffage et
de Ventilation. Ann. d'Hygiene, 1852, tome xlvii. p. 241.

VENTILATION OF HOSPITALS. > 433

crowded condition of the wards of hospitals produced the
most excessive mortality. In 1786 the Academy of Sci-
ences appointed a commission to inquire into the state
of the hospitals, in regard to which there was a great deal
of complaint. The following extract, from the report of the
Commission in relation to the Hotel-Dieu, exhibits the de-
plorable condition of the patients of this institution : —

"They (the commissioners) have seen the dead mingled
with the living, wards the passages to which are narrow,
where the stagnant air is not renewed, where the light only
feebly penetrates, and which are loaded with humid vapors.
The commissioners have seen the convalescents mingled in
the same wards with the sick, the dying, and the dead; the
ward for the insane contiguous to that of the unfortunate
patients who have undergone the most severe operations,
and who cannot hope for repose in the vicinity of these
maniacs, whose frantic cries are heard day and night. A
patient coming in is placed in the same bed, and in the
same bedclothes used by a patient with the itch, who has
just expired. The itch is almost general — it is perpetual
in the Hotel-Dieu — the surgeons, the visitors, the nurses
contracting it, either in dressing the patients or in hand-
ling their clothes. The patients discharged, who have be-
come affected, take it to their families; and thus the Hotel-
Dieu is an inexhaustible source from which this disease is
spread throughout Paris. The operating ward contains
those who are being operated upon, those who are to be
operated on, and those upon whom operations have already
been performed. * * * * Saint Joseph's ward is devoted
to pregnant women; the respectable and the depraved are
there together, three or four in that state lying in the same
bed, exposed to sleeplessness and the contagion from their
diseased companions, and to the danger of injuring their
infants. The women who have been delivered are also
situated three or four in a single bed at different periods of

434 < A TREATISE ON HYGIENE.

their recovery. * * * * Independently of all other
causes which tend to corrupt the air of this hospital, when
it is necessary to change the straw of the beds, as there is
no place set aside for this work, it is done in the ward.
When the beds upon which so many invalids have reposed
are opened, the odor which is exhaled may readily be con-
ceived. In addition, each ward contains several beds of
straw for the dying and for those who have soiled their
beds. On this straw sometimes as many as five or six are
placed. It is simply packed up on the bedstead and cov-
ered with a sheet. It is sometimes the case that here, in
the midst of the dying and the filthy, the patients, who
have not yet been assigned to wards, are placed. It is
necessary to witness these horrors, to be convinced of their
existence; or rather it would be necessary to fly from them,
to remove them from the thoughts, if it were not indispens-
able to be aware of their existence, in order to make known
the terrible condition which prevails, and to rectify it."*

As a general rule, the hospitals of the present day on the
continent of Europe are not so well ventilated or kept in as
good a condition as those of Great Britain and the United
States.

It is perhaps scarcely requisite to dwell at greater length
on the absolute necessity of ventilation, in order to prevent
infection and to accelerate the recovery of invalids, but the
following case is so much to the point that it is brought
forward as illustrating, in a striking manner, the dangers
of confined air. Dr. B. W. Richardson,-)- in an essay on
scarlet fever, says : —

"At a short distance from one of our villages there was
situated, on a slight eminence, a small clump of laborers'
cottages, with the thatch peering down on the beds of the

* Des Hopitaux, etc. Par le Docteur Felix Roubaud. Paris, 1853,
p. 79.

f Clinical Essays. London, 1862, p. 92.

VENTILATION OF HOSPITALS. 435

sleepers. A man and his wife lived in one of these cot-
tages, with four as lovely children as England ever owned.
Not those immortal Angles, whom Pope Gregory recognized
as angels in the slave-mart of Rome, were more worthy of
our country. But the poison of scarlet fever entered this
poor man's door, and at once struck down one of the flock.
I had no time allowed me for the practice of any special
remedy; but it seemed to me that I had saved the remain-
ing children by obtaining their removal to the care of a
grandparent, who lived at a village a few miles away.
Some weeks elapsed, when one of these was allowed to
return home. Within twenty-four hours it was seized with
the disorder, and died with equal rapidity to the first. We
were doubly cautious in respect to the return of the other
children. Every inch of wall in the cottage was cleaned
and lime-washed; every article of clothing and linen was
washed, or, if bad, destroyed ; floors were thoroughly
scoured, and so long a period as four months was allowed
to elapse before any of the living children were brought
home. Then one child was allowed to return, a boy nine
years of age. He reached his father's cottage early in the
morning ; he seemed dull the next day, and at midnight in
the succeeding twelve hours I was sent for, to find him also
the subject of scarlet fever. The disease again assumed
the malignant type, and this child died, despite all that
could be done. I recommended, after this event, that the
cottage should be newly roofed; but I am unable to say
whether any such precaution was taken, for soon afterward
I left the neighborhood for good. I have always believed
that in this instance the thatch was the medium in which
the poison was retained."

An important question to be considered, when treating
of ventilation, relates to the extent to which different strata
of the atmosphere of a room become vitiated by the effluvia
of the inmates. It was considered that the air changed by

436 A TREATISE ON HYGIENE.

respiration occupied the lowest part of the room, and hence
systems of ventilation were devised based upon this sup-
posed weight of the deteriorated air. Leblanc,* however,
showed that the air collected at the Opera Comique, after a
performance at which a thousand persons were present, and
after means had been taken to purify it, contained in the
upper part of the room 43 parts of carbonic acid in 10,000
of air, and in the lower but 23 parts in 10,000. This hall
was well ventilated by a flue over the chandelier, by which
80,000 cubic metres of air were discharged per hour.

In this case, the very great preponderance of carbonic
acid in the upper strata can only be ascribed to the influ-
ence of the upward current excited by the ventilator, and
to the position of the gas-lights.

Subsequently Lassaigne,f who appears to have studied
the subject closely, arrived at results differing materially
from those obtained by Leblanc. He found that the air of
an amphitheater, after fifty-five persons had been in it for
an hour and a half, contained in that collected at a distance
of twelve feet from the floor 0*62 per cent, of carbonic acid,
while in that taken at the level of the floor 0*55 per cent,
was present. It is probable that this small difference was
either accidental or due to the ordinary error in the
analyses.

According to the law of the diffusion of gases, they
mingle with each other without regard to specific gravity.
Thus, if ajar of carbonic acid gas be placed under, but in con-
tact with one containing air, in such a manner as to assure
free communication of the contents, it will be found that in
a short time an interchange will have taken place, carbonic
acid will have ascended into the upper jar, and may be
detected by lime-water, and air will have descended into

* Op. cit, p. 235.

f Annales d'Hygiene, 1846, tome xxvi. p. 297.

VENTILATION OF HOSPITALS. 437

the lower jar, notwithstanding that the specific gravity of
carbonic acid gas is more than a third greater than that of
atmospheric air.

It is not to be supposed, however, that this commingling
is a rapid process; on the contrary, it is very slow, and
hence, in a hospital ward, it will always be found that, if
care is taken to avoid currents while conducting the experi-
ment, a greater amount of carbonic acid will be found in
the lower strata of air than in those nearest the ceiling.

I examined the air of a small room in which three adults
had respired for two hours, during which time the windows
and doors were closed. I found that the air collected at the
distance of eight inches above the floor contained 83 per
cent, of carbonic acid, or 8 - 30 parts in 1000; while that col-
lected at a distance of twelve feet from the floor contained
but 0*68 per cent., or 6 # 80 parts in 1000 of air.

With regard to the organic matters given off by respira-
tion and exhalation from the skin, the case is different, as
they are always, so far as my observation extends, found in
greatest abundance in the upper portion of an apartment'
in which persons have been recently present. At the same
time that determinations relative to the proportion of car-
bonic acid were being made, I conducted observations in
regard to the last-named point, and found that, while a
standard solution of permanganate of potassa, placed at a
distance of eight inches above the floor, required 865 cubic
inches of air to pass through it before it was decolorized,
680 cubic inches sufficed to produce this result at a dis-
tance of twelve feet above the floor.

Holes, therefore, made in the floor for the purpose of
allowing the vitiated atmosphere to escape, do not effect
this object. In the first place, in winter, when the tempera-
ture of the ward is always greater than that of the external
air, currents will invariably be excited in the opposite direc-
tion, and, as the air is not warmed before being distributed

438 A TREATISE ON HYGIENE.

throughout the ward, a reduction of temperature and irreg-
ular currents are produced. In the next place, the error
has been much too common, that the principal deleterious
exhalation from the human body is carbonic acid ; and
hence the main object has been to remove it from the
apartment, ignoring, in a great measure, the far more inju-
rious matters in the upper part of the room.

With reference to the amount of fresh air required for a
healthy man in a given time, much difference of opinion
has existed. Thus Vierordt fixes the amount at 2i cubic
feet per minute, Dr. Reid at 10 cubic feet, and Dr. Arnott
at 20 cubic feet. The first of these is undoubtedly too low,
and the last cannot be considered as at all too high. From
the nature of the problem to be solved, and from the many
influences in operation capable of affecting the result, it is
extremely difficult, if not impossible, to arrive at exactness.
It may, however, be safely affirmed that, in a ward in
which 1200 cubic feet of air are allowed to each patient,
this amount should be entirely changed in each hour at
the most, and this would require the admission of 20 cubic
feet per minute for each patient. An allowance of 30 to 40
cubic feet per minute would, however, be far preferable.
The object should be to render the atmosphere of the ward,
as nearly as possible, similar in composition, as regards car-
bonic acid, aqueous vapor, and organic matter present, to
that of the external air. In the summer, when the win-
dows and doors of apartments are kept open, it will be no
difficult matter to effect this. I found that a room contain-
ing 1500 cubic feet, in which I remained six hours with the
window and door closed, had the air entirely renewed by
leaving the window and door open for fifty-five minutes.
The amount of carbonic acid present at the expiration of
the six hours was 072 per cent., and this was reduced to
the proportion existing in the external atmosphere (0-39)
in the time stated.

VENTILATION" OF HOSPITALS. 439

Means of Ventilation. — Ventilation is of two kinds —
natural and artificial. Natural ventilation simply consists
in the employment of such ordinary means, in conjunction
with nature, as are at hand in all dwellings, or which
require no special machinery, improving them, and making
the most of any advantages to be derived from their use.
Thus the proper management of doors and windows, the
construction of flues and openings to the external atmos-
phere, in which currents of air entering the rooms and
going out of them are induced, without the employment of
special apparatus or moving power, belong to this head.
When it is possible to make use of natural ventilation it is
to be preferred, not only on account of its cheapness, but
also because it is more agreeable and effectual.

By erecting hospitals according to the pavilion principle,
natural ventilation can be employed with great advantage,
because three sides of the ward, and sometimes all four, are
exposed to the full influence of the atmosphere; and thus
through the windows and doors alone fresh air enters, and
that which has become vitiated obtains an effectual means
of exit. I have seen the air of a room containing 5000
cubic feet entirely renewed in the space of five minutes, by
the windows and doors alone, when a moderate breeze has
been blowing. In this climate, however, the doors and
windows of wards cannot be left open a sufficient length of
time, during the cold seasons, to allow such a free circulation
of air as is requisite for the health of the inmates of hos-
pitals, as the wards are constantly occupied. But in dwell-
ing-houses the air of all bed-rooms and other apartments,
occupied by individuals during night or day, should be
thoroughly changed at least once in the twenty-four hours,
no matter how cold or inclement the weather may be.

It, however, becomes a matter of necessity to provide for
an efficient ventilation of hospital wards by some other
plan than windows and doors alone. No better method

440

A TREATISE ON" HYGIENE.

than that already described as ridge ventilation can be
employed, and with very little additional expense it could
be readily made available for all seasons of the year, ex-
cept perhaps in the extreme northern parts of the country.
There is, however, among those who do not understand its
action, a prejudice which it is difficult to overcome. In
fact, there is more or less feeling against all external open-
ings during cold weather, both on the part of many medical
men and nearly all patients. The fear of a draught of air
is almost universal among civilized people; the fear of a
vitiated atmosphere seldom occurs to them : and yet the
bad effects of breathing air contaminated with the emana-
tions from the body, the products of combustion, etc. are
infinitely worse than any to be apprehended from a current
of air. Even for permanent hospitals built of brick or stone
the ridge ventilation is the best that can be devised. Fresh
air heated should be supplied in abundance, and the vitiated
atmosphere should be allowed to escape through an opening
extending the whole length of the ridge. If the air entering
the wards of the temporary hospitals were heated by passing
over coils of pipes containing steam or hot water, it would
be perfectly practicable to retain the great advantages of
the ridge ventilation throughout the space. The walls
should be double, after the pattern of those figured on page
441, and the ceiling should be arched over, leaving an open
space in the center, which might be partially closed by a .
perforated plate of iron, but which should allow of free
communication with the external air. Of course this would
necessitate the erection of pavilions but one story high, but
this would be an advantage in every respect. The open-
ings in the sides of the ward through which the fresh air is
admitted should also be covered with perforated iron plates,
and the space between the two walls should contain the
heating apparatus. A plate of iron should be placed be-
tween the walls, so as to force the heated air to enter the

VENTILATION OF HOSPITALS.

441

ward through the opening near the floor. Both the ex-
ternal and internal openings should extend the whole
length of the pavilion. The arrangement is shown in

section in Fig. 69.

Fig. 69.

SECTION OF PERMANENT RIDGE VENTILATED HOSPITAL.

I cannot conceive of a more efficient system, both of heat-
ing and ventilating, than this, nor one which is more simple
in its operation.

442

A TREATISE ON HYGIENE.

In apartments in which it is impossible to secure ridge
ventilation, a great deal can be done by the construction of
flues, by which the foul air is removed from the room. One
of the best of these, and one which can readily be adapted
to permanent buildings, is that of Dr. Arnott, and which is
shown in Fig. 70.

It consists of a metal box inserted into the chimney near
the ceiling, and over the inner opening of which a perfo-
rated metal plate is placed. When a fire is lighted in the
fire-place or stove connected with the chimney, the vitiated
air is drawn from the room through the opening. Over the
inner face of the perforated plate a piece of silk fastened by
the upper edge is placed, so that downward currents into
the room, by which smoke would enter, are prevented.

Fig. 70.

Fig. 71.

A very good means of ventilation, so long as the wind
blows, consists in flues through which a current of air is
excited by the tendency to a vacuum created by cowls
placed at their summits. Or a double arrangement may
be made, by which the flues on one side receive fresh air,
while that which has become vitiated escapes through them
on the other side. An idea of this system will be obtained
from an examination of Fig. 71. This plan is only fully
effectual while the wind blows.

VENTILATION OF HOSPITALS. 443

There are many other plans of natural ventilation which
are more or less modifications of those mentioned, and
which receive elucidation in the special works on the
subject.*

The means for effecting artificial ventilation are also
numerous, but are almost always connected with the ar-
rangements for heating. The air may be forced into the
room by machinery, or caused to enter it from a source
below the level of the apartment through its less specific
gravity, in consequence of being heated. This plan only
looks to the supply of fresh air; that which has become
foul being allowed to escape through the cracks of the win-
dows and doors, the chimney or flues. By another system,
the attention is principally directed to the removal of the
vitiated atmosphere, leaving the fresh air to find its way in
as best it may. Flues are constructed which converge to a
larger flue opening to the outside. In this last a fire is kept
burning or heat applied in some other way. The conse-
quence is, that currents of air are excited through all the
flues, and the foul air is extracted. A third system consists
in a combination of both those mentioned. The air is
forced into the room by a fan or screw, and heated before
its entrance, by passing over pipes containing steam or hot
water. It is then extracted through flues communicating
with a hot-air chamber, which opens to the external atmos-
phere. The Episcopal Hospital in Philadelphia is heated
and ventilated by this last system, and I can speak from
experience of the admirable manner in which both modes
are accomplished. The power of extraction produced by
hot-air flues is very great, and they may be applied to the
ventilation of almost any room with great advantage.

* One of the best works on the subject, to which the student is referred,
is the Practical- Treatise on Ventilation, by Morrill Wyman, of Cambridge,

Mass.

444

A TREATISE ON HYGIENE.

In Fig. 72 the plan adopted by the late Dr. Reid for
heating and ventilating the temporary House of Commons

Fig. 72.

v/v/W W^v/v/Y/Vi }

^. j-- && **» tad >y aa* ■*** J &

I-

is shown. "The air enters at the turret on the left, and is
heated or cooled to the required temperature, by hot or cold
water pipes or otherwise, below the floor of the house or in
any adjoining apartment. From the main trunk below, the
air is either allowed to escape, diffusing itself equally below
the whole of the floor, or led away by separate tubes, so as
to ascend by the same equal flow, whether entering by
numerous small apertures in the grating along the floor
or below each individual seat along its whole extent. The
row of arrows represents the apertures by which the pre-
pared air enters the body of the house, whether along the
floor or below any single bench. Ventilating apertures,
placed between each pendant in the roof, remove the air as
it rises, which now descends, as is represented, till led into
the chimney; the furnace at the bottom, though small, being
capable of working the whole of the ventilating apparatus.
At a a two doors are placed, by opening or shutting which,
according to the state of the furnace, the velocity of the
current from and into the house may be increased or dimin-
ished almost to any extent in an instant. The furnace is

VENTILATION OF HOSPITALS.

445

worked by coke alone, the doors a a being shut on kind-
ling it, and air admitted for a short time by the ash-pit
doors.

"Delicate but large thermometers, placed within the
house, and also in the main ventilating pipes as they enter
and leave it, guide the attendants, and are at the same
time a complete check upon the regularity with which
every part of the operation is carried on."

Fig. 73 shows the arrangement adopted in some of the
United States Army hospitals for ventilating the latrines.
A strong downward current is excited by the stove, and all
the effluvia carried off.

Fig. 73.

It would be very easy to adduce many other plans of
ventilation by artificial processes, but it is believed that

446 A TREATISE ON HYGIENE.

enough has been said to indicate the principles by which
they are governed. The main object aimed at has been to
leave no doubt on the mind of the reader relative to the
noxious character of air which has become contaminated
by animal effluvia or by the several processes of illumination
and heating in use. If success has been attained in this
direction, the means of securing a supply of fresh air and
of freeing the inmates of a hospital from that which they
have vitiated will be sufficiently apparent from what has
been said on this part of the subject, or if not, the main
points will have been so far rendered evident that the in-
telligent medical officer will be able to apply the principles
to practice. And this concludes what we have to say with
special reference to hospitals. If the limits or character of
this work permitted, a great deal could be written relative
to the principles which should prevail in the management
of military hospitals. Some of these will of course be
referred to under the heads of Food and Clothing, but such
as relate to the discipline of hospitals, and the duties of
the officers and attendants, do not properly come within
the scope of a treatise o,n hygiene.

CHAPTER XIX.

BARRACKS.

Much which would have been written relative to bar-
racks, in an essay specially devoted to their consideration,
has been brought- forward under the several heads relating
to hospitals, so that there is little to be said in regard to
them without going over ground already traversed. With
reference to their construction, the principles do not vary

BARRACKS. 447

essentially from those applicable to hospitals. From the
fact, however, that they are inhabited by well men, who
are not confined to them day after day as are patients of a
hospital ward, so large an allowance of superficial and
cubic space as is given to the sick is scarcely necessary.
In permanent barracks 600 cubic feet of air, if the ventila-
tion is properly looked after, will be found ample, and in
temporary structures, ventilated at the ridge, 400 to 500
will be sufficient.

As measures of health, every barrack should be pro-
vided with bath-rooms, ablution-rooms, and mess-rooms.
The dormitories should be of such a size as to contain a
company with the space above mentioned. Fifty square
feet should be allowed to each man. The windows and
doors should be large, and the barrack should be sur-
rounded with a veranda, in which the men can walk
during inclement weather.

The barracks at Fort Riley in Kansas are the best I
ever saw. They are built of stone, and are two stories
high. In the lower story are the kitchen, mess-room, ab-
lution-room, orderly-room, store-room, etc. The whole of
the upper floor is the barrack-room. Each building is a
unit, and is intended for the accommodation of one com-
pany. The barracks occupy two sides of a square, and the
officers' quarters the other two sides. The intervals be-
tween the buildings are, however, wide enough to allow of
a free circulation of air.

448 A TREATISE ON HYGIENE.

CHAPTER XX.

CAMPS.

Camps are ordinarily formed of tents — unless a more per-
manent character is designed for them than can be ob-
tained from such structures, when sheds or huts are built
for the purpose of more effectually sheltering the troops.
Camps are in their very essence unhealthy; they are even
more so than large cities, because less attention is paid
(oftentimes necessarily) to those points — such as sewerage,
drainage, heating, ventilation, etc. — which exert so great
an influence over the health of the inhabitants. At the
same time there is no positive reason why many measures
which are now frequently overlooked should not be carried
out, with the effect, which would be sure to follow, of
improving the health, and, consequently, adding to the
efficiency of the troops.

Tents are generally made of cotton-duck, which, on ac-
count of its greater imperviousness to water, and cheapness,
is preferable to linen or hemp. Great variety prevails in
regard to form. The wedge-shaped tent, some years since,
was entirely used for the men, and the wall tent for officers.
Latterly, however, the wedge-shaped tent has fallen into
disuse, having been superseded by the Sibley tent, which
in many respects is far preferable, though in others falling
short of what is required in a good tent.

The great advantages of the Sibley tent are that it admits
of being readily warmed by an open fire, and of efficient
ventilation, in winter. It is of conical form, with an open-
ing at the apex, which is partially covered by a movable

camps. 449

cowl, so arranged as to be easily shifted, according to the
direction of the wind. Around the opening an iron ring is
attached which is connected to a central pole by three
chains. This pole supports the tent, but does not extend
to the ground — a tripod, the legs of which are hinged,
being affixed to the lower extremity. By opening or
closing the legs of the tripod, the tent is elevated or
lowered. The principal objection to be urged against the
Sibley tent is that as there is no perpendicular wall to it,
the edge is directly attached to the ground, and cannot be
raised so as to allow of a free circulation of air through the
tent. If the Sibley tent was furnished with a wall three
or four feet high, and the conical roof instead of touching
the ground was connected with it by cords, the wall could
be raised and the air thus caused to pass through the tent.
With this addition the tent would be as perfect as any tent
could be. As it is, it fulfils the requirements of health
better than any other in use.

The Sibley tent is not an original idea. The Camanche
lodge is constructed upon the same principle, and is even
superior to it in the means of support. The Sibley tent is
occasionally supported in permanent camps by three poles
fastened together at one end and separated so as to form a
tripod — the tent being hung from the apex. In this way
more room is obtained.

The Sibley tent is intended for fifteen infantry soldiers
or thirteen mounted men. In permanent camps these
numbers should be reduced to twelve and ten.

The bell tent is also in use in the army, and is the next
best to the one just described. A window is cut in one
side near the top, which can be closed by a canvas flap.
In this way ventilation is secured.

The officers tent is square, and has a wall four feet high,
which can be raised all around. It is also supplied with
a fly, by which the heat of the sun and rain are more
effectually kept from entering.

450 A TREATISE ON HYGIENE.

The hospital tent is made of heavier canvas than any of
those mentioned. It is 15 feet square, has a wall 4 \ feet
high, and is 12 feet high to the ridge. It is furnished with
a heavy fly. It is open at both ends, and is so arranged
that two or more can be joined together, forming a con-
tinuous ward.

Each tent will accommodate comfortably six men in bed-
steads, three on each side, leaving a passage in the center
of 2 2 feet in width, and the same distance between the
beds. No special means are provided for the escape of
the foul air except by raising the wall and opening the
flaps in the ends. It would be well if windows, capable
of being closed in very inclement weather, were cut in
the roof. These would be at all times covered by the fly,
but would allow of the escape of vitiated air.

In a hygienic point of view, tent hospitals are the very
best of all, and during warm weather should be preferred
for all classes of patients. Even in the midst of winter,
they can be made exceedingly comfortable by stoves, and
can be ventilated by the plan a description of which is
given on page 357. They should always be floored with
boards, loosely put down, so as to admit of their being re-
moved, and the ground beneath aired occasionally. The
common tents of all permanent camps should also, if pos-
sible, be floored after the same manner.

In pitching tents, the principles which have already been
laid down, under the heads of Soil and Locality, should pre-
vail. Too much care cannot be taken in the selection of
the ground, and in providing such a location as will admit
of the troops supplying themselves with good water and
wood. A trench, eight or ten inches deep, should be dug
around each tent, and should lead, with the trenches from
the other tents, into a larger one for each street, capable of
allowing the water to flow from the camp-ground. Tents
should, in all permanent encampments, be frequently

CAMPS. 451

struck, and the ground upon which they have been pitched
thoroughly aired.

The inside of tents should never be excavated. Nothing
is more productive of zymotic diseases than the practice,
which too frequently prevails, of cutting the ground down
within the tents, so as to leave a wall of earth as a barrier
against the entrance of fresh air, and as a most effectual
absorber of the effluvia from the bodies of the inmates. It
is quite recently that a medical inspector of the army re-
ported that a regiment, which went into a camp composed
of excavated huts, was attacked immediately with typhus
fever. They were at once abandoned, new huts without
excavations were constructed, and good health once more
prevailed.

Huts are often built by the troops when there is a prob-
ability of the camp being somewhat permanent. They
should be large enough to contain 20 men, with 400 cubic
feet and about 40 feet superficial area per man. They should
be ventilated at the ridge, and should be arranged after
the same plans and built generally in the same manner as
those already specified for hospitals. The ground for huts
should be thoroughly drained — a porous soil being, for the
reasons previously stated, preferable to any other — and
they should be so situated as not to be subject to overflow
from the water drained from higher ground in the vicinity.

Arrangement of Tents and Hats. — No regulations in re-
gard to the arrangement of tents, since the adoption of the
Sibley tent, have been published. The present regulations
are applicable only to the wedge or A-shaped tent. For
a regiment of infantry on the peace footing, 80 of these
were allowed, 6 men being the complement for each. The
extent of surface covered by the men's tents was 48 yards
by 400 yards, equal to 19,200 square yards. Each tent
had therefore an allowance of 215 square yards, which was
equivalent to 14,408 tents to a square mile, which, as each

452 A TREATISE ON HYGIENE.

tent contained 6 men, gave a total population, to a camp
pitched according to the regulation, of 86,448 to the square
mile.

In regard to the overcrowding of men in camps, the same
remarks are applicable which were made on the subject
when hospitals were under consideration. It is no matter
of astonishment that soldiers exhibit a higher sickness rate
than civilians, when the fact is brought to mind that all
camps are more densely populated than many large cities.
The regulation camp above referred to gives a density of
population of 86,448 to the square mile, while London has
but 50,000, Birmingham 40,000, Philadelphia 45,000, etc.
The following remarks from the Report of the Commission
on Barracks and Hospitals, so often referred to, are so
appropriate, that I have not hesitated to quote them in
full :—

"As regards the arrangement of tents and huts, it may
be laid down as a general rule that the more space allowed
between them for ventilation, the more healthy will the
force be; but the area over which it is possible to spread a
force must necessarily depend on the size of the ground and
on the nature of the service. Some general principle should
nevertheless be adopted in dealing with the question. It
has been shown in the Report of the Royal Commission on
the Sanitary Condition of the Army that the Quartermaster-
General's instructions, issued at the commencement of the
Crimean war, authorized densities on the camp surface
equal to 347,000, 348,000, and 664,000 inhabitants per
square mile. The lowest of these densities is double that
of the most densely populated district in England. It
includes not only the ground actually covered by tents, but
all the open spaces in the camp. The ground actually cov-
ered by tents in these plans of encampment gave a density
of population equal to 1,044,820 per square mile.

"The influence on health of surface overcrowding in

camps. 453

towns is now well known, and there cannot be a doubt
that surface overcrowding in camps is a common cause of
camp diseases. A camp is a temporary town without pav-
ing or proper drainage. It is only by paving and drainage
that the deleterious influence of surface overcrowding in
towns can be reduced to a minimum. But paving and
drainage cannot be carried out to a sufficient extent in
camps to enable the surface to be crowded, and therefore
as large an extent of space should be given as the nature
of the ground or of the service will admit.

"At the time of the Health of Towns' Inquiry, it was
found that the approximate density of population on the
built area of five of the principal towns of England was as
follows : —

m Inhabitants per

Towns - square mile.

Leeds 87,256

Metropolis (London) 50,000

Birmingham 40,000

Manchester (township) 100,000

Liverpool (parish) 138,224

"It was, moreover, found that the proportional annual
deaths from fever in these towns increased with the den-
sity.

"In the report of the Royal Commission on the Sanitary
State of the Army, the following examples are given of the
more densely peopled districts of the metropolis : —

_.. , . , Inhabitants per

District, square mile.

St. James, Westminster 144,008

Holborn 148,705

St. Luke 151,104

Strand 161,556

East London 175,816

"All these examples, drawn from towns, occur in places
where paving and draining have been more or less carried

454

A TREATISE ON HYGIENE.

out, and where, nevertheless, the influence of surface over-
crowding on health is obvious, on a comparison being made
with less crowded districts. If we compare any of these
densities with the authorized densities for camps, which
have neither drainage nor paving, given above, we shall be
able to form some estimate of what is likely to be the influ-
ence on health of surface overcrowding in camps.

"Assuming a square mile = 3,097,600 square yards, and
15 men to a tent, as our units of comparison, the following
table will give the surface area per tent for different densi-
ties of population per square mile : —

Number of square yards

Number of tents per

Number of troops per

per tent.

square mile.

61,952

929,280

100

30,976

464,640

150

20,650

309,760

200

15,488

232,320

300

10,325

154,880

400

1,744

116,160

500

6,195

92,928

600

5,162

77,440

700

4,425

66,377

800

3,872

58,080

900

3,441

51,626

1000

3,097

46,464

1100

2,816

42,240

"It appears from this table that to allow 350 square
yards per tent would give a density per square mile equal
to that of Liverpool; about 450 square yards per tent
would give a density equal to that of Manchester; and 900
square yards per tent would give a density equal to that of
the built part of the metropolis; and to reduce the surface
density to that of Birmingham would require also 1200
square yards per tent to be allowed.

"The Quartermaster- General's Regulations referred to
would, if rigidly carried out, allow no more than from about

CAMPS.

455

70 to 134 square yards per tent; but in estimating the
probable effect of this area upon health, we must revert to
the fact already mentioned, that the town districts used in
the comparison are paved and drained, while camps are not.
"As already stated, the number of troops to be placed on
a given area must be determined by local circumstances;
but the tables we have given will be useful in enabling a
correct judgment to be formed as regards one very import-
ant element in the sanitary state of camps, namely, density
of population.

"The manner of arranging tents is of importance to
health as well as to cleanliness. Battalion camps are not
unfrequently arranged in such a way that the tents touch
each other, except where a narrow passage is left between
the rows for access. A camp so arranged can never be
clean nor healthy. In cleaning out one row of tents, the
dust is merely driven into the adjoining row. Thorough
ventilation is impossible, and as regards the unhealthiness
of such an arrangement, every army medical officer is in
the habit of recommending the spreading of tents over a
larger surface, as one of the most efficacious means of arrest-
ing epidemic disease in camps, a sufficient proof of the rela-
tion between camp epidemics and surface overcrowding.

"Battalion tents should never be arranged in double line;
short single lines are best. The tents in line should be
separated from each other by a space at the very least
equal to a diameter and a half of a tent, and the farther
the lines can be conveniently placed from each other the

better."

Of course these remarks are equally applicable to the
huts, which the troops generally build in cold weather.
My own observation has satisfied me that they are invaria-
bly placed too close together, and that but little attention
is paid to ventilating and draining them. An instance of
the evil results of excavating the floor of huts has already

456 "A TREATISE ON HYGIENE.

been given; one equally striking illustration of the conse-
quences of banking earth against the sides is afforded by
the camp of the 79th Highlanders, as it was established in
the Crimea: —

"Part of this regiment occupied a range of wooden huts
and tents immediately under the steep descent from Marine
Heights, at an elevation of about 550 feet above the level
of the sea. The ground was a porous, sandy loam, with a
considerable water-shed above it. In preparing the ground,
sites for huts had been dug out of the slope, and the earth
was heaped up against their sides. The surface was not
sufficiently drained, and the huts were not properly ven-
tilated.

"The remaining part of the 79th were, for special mili-
tary reasons, encamped 100 feet lower down, where the
ground was soft and wet. The ground sloped rapidly
toward this part of the camp, and, from the configuration
of the surface, the drainage from Marine Heights above
was concentrated in a hollow, within which a number of
huts had been erected for the men more immediately en-
gaged in the defense of the works, which passed close to
the doors. A few of these lower huts were erected above
the hollow, and with a good natural drainage.

"The whole of the ground was wet and traversed by
superficial drains, and it had, moreover, been extensively
turned up in constructing the works. In erecting the huts,
the space cut out of the slope was just sufficient to hold the
hut, and the earth was left in contact with the boarded
sides for two or three feet in height."

Fig. 74 shows a transverse section of the upper end of
one of these huts.

"The attention of the Commissioners was first specially
directed to this part of the camp by a representation from
Sir Colin Campbell that fever had been very prevalent
among the troops occupying it. On the 13th of April,

camps. 457

1855, the Commissioners met Sir Colin Campbell by ap-
pointment, and proceeded to make a careful examination
into the circumstances.

Fig. 74.

"It appeared that shortly after the ground was occupied,
in the end of October, 1854, zymotic diseases, chiefly diar-
rhoea, -with a few cases of fever and cholera, occurred among
the men. From the week ending 31st October until the
date of our inquiry, 80 per cent, of the sickness in the regi-
ment had been occasioned by zymotic diseases. Diarrhoea
cases were most numerous until the week ending January
16th, 1855, and there were comparatively few fever cases
before that date. From the 16th January till the 18th
April, the time when the measures recommended by the
Sanitary Commission were taken, above 74 per cent, of the
total sickness had been caused by fever. During the week
ending April 11th, out of 64 cases, 60 were from fever.
The type of fever was remittent, passing into the typhoid
form, strongly marking the causation. At the time fever
prevailed, the other forms of zymotic disease had nearly
disappeared.

"There had been some fever in the range of huts under
Marine Heights, but the majority of the cases were confined
to the huts on the wet ground close to the works. There
was little or no fever in tents in the vicinity.

"In addition to the topographical defects already men-
tioned, we found the floors of the infected huts very damp;
and on removing the boarding, the surface of the ground

458 A TREATISE ON HYGIENE.

beneath was found covered with the threads of fungi, and
the atmosphere in the huts had the peculiar odor and damp-
ness usually experienced on going into an underground
cellar.

" So wet was the sub-soil that water was found under one
of the angles of a hut. The men slept on the boarding
hardly raised above the ground, and breathed the damp
malarial atmosphere arising from it. The cubic contents
of the huts were 3645 feet, and allowing twenty-five men
to a hut, the cubic space per man would be about 146 feet.
The ventilation was insufficient, and, under all the circum-
stances, the huts were overcrowded."

The Commissioners very properly recommended that
either the troops should be removed or the sanitary con-
dition of the huts improved, by digging away the earth
banked against their sides, and draining each hut sepa-
rately by a trench extending around it, and about a foot
below the floor of the hut; and that the huts should be
ventilated at the floor and ridge, and the number of men
in each reduced.

Lord Raglan at once proceeded to act on these sugges-
tions, and the consequence was that the fever immediately
abated, and the condition of the sick commenced to improve.

Some of the huts — those on the wet ground — were va-
cated by the 79th Regiment; about a month afterward the
31st Regiment arrived and took possession of them. At
this time the strength of the regiment was 873. On the
1st of June a case of cholera occurred, and between this
date and the 16 th there were 34 deaths from cholera and a
great number of cases of diarrhoea. The company most
severely affected occupied the bad huts. On moving this
company higher up, the disease abated.

The 31st left the huts on the 16th of June, and they
remained vacant until the early part of the following Sep-
tember, when they were occupied by three companies of the

camps. 459

Royal Artillery, a fourth company being encamped on dry
ground outside of the lines.

On the 7th of October cholera broke out among the men
inhabiting the huts on the wet ground. Seven deaths oc-
curred from the disease, and diarrhoea became very preva-
lent. Finally, the medical officers ordered all the bad huts
to be taken down and rebuilt on better ground higher up.
They were reoccupied by the same men, and one more
death from cholera took place before the disease disap-
peared.

The fourth company, which was in camp outside the
lines, but only a short distance from the affected huts,
escaped the disease altogether.

The ground upon which the huts had stood was ex-
amined after their removal, and found perfectly saturated
with water.

A more instructive instance of the impropriety, not to
say criminality, of requiring men to inhabit buildings so
situated as the huts on the Marine Heights, is scarcely to
be found, and should be a warning which at this time we
should not hesitate to heed. A persistence in violating
the laws of hygiene is certain to bring disaster, and yet so
many act as though the consequences were of little import-
ance, or even as though there were no consequences at all.

Latrines. — The latrines should be situated at least 150
yards from the tents. This is the distance required by the
General Regulations of the Army, and is not at all too great.
They should be situated to leeward of the camp. A deep
and narrow trench should be dug for the purpose; if too
wide it will require more earth to cover the excreta, and
will, moreover, expose a greater surface from which the
noxious effluvia will be given off than if it is narrow.
Every evening the accumulations of the day should be
covered with at least a foot of earth. As we have seen,
earth readily absorbs the matters which are given off by

460 A TREATISE ON HYGIENE.

putrefying substances. After the trench has become filled
to within three feet of the top it should no longer be used,
but should at once be filled up with earth.

Latrines should not be made over streams of water or in
the vicinity of springs or wells. In either case the water
will become contaminated, and serious disease may be the
result.

Police. — In all camps the most complete attention should
be given to cleanliness. The streets should be swept regu-
larly every day, and the dirt carted away. Tents should
be thoroughly aired by opening the doors and raising the
walls after- the men have left them in the morning. All
bedding should likewise be exposed to the air every day
unless the weather is such as to prevent it. Straw which
has been used a week should be replaced by fresh — the old
being burned.

/Slaughter pens should be placed at a considerable dis-
tance from the camp, and in such a position that the
effluvia cannot incommode the troops. They should often
be purified with chloride of lime or other disinfectant.
The offal should be burned.

Horses and other animals should not be kept near the
men. In cavalry camps other reasons than those of a
sanitary nature require the horses to be so placed as to be
within easy reach in case of necessity. The picketing-
ground should always, however, be to leeward of the camp.
Dead animals, dung, and other refuse should be burned.

Medical officers have it in their power to do much toward
improving the hygienic condition of camps and adding to
the comfort of the men. It rarely happens that command-
ing officers refuse to listen to their suggestions, if made in
good faith and based upon the principles of common sense.
Baron Desgenettes, who was the principal medical officer of
the Army of Egypt, relates that one morning at daybreak
Napoleon found him examining the latrines. "What in

CAMPS. 461

the devil are you doing there?" said the general. "I am
attending to my duty," replied Desgenettes, "and I expect
on this occasion to find something for your next general
order." In the evening the general sent for him, and ques-
tioned him more particularly in regard to the incident of
the morning. Desgenettes explained to him fully the dan-
ger of the exhalations from latrines, and that he was
anxious to find some means of neutralizing their bad
effects. Bonaparte listened with attention, and when the
baron had finished expressed his satisfaction with the
devotion to duty and care for the health of his troops by
which Desgenettes was actuated.

There are many other points than those specified con-
nected with the hygiene of camps, which will receive
attention under the heads of Food and Clothing.

With reference to the health of the large camps which
have been established by the United States Army since the
commencement of the present rebellion, the reports which
have been received from medical directors and military
commanders go to show the excellent sanitary condition
which has generally prevailed. There have been some
exceptions, but it is a matter of congratulation that they
have been few. In the Army of the Potomac during the
last winter the sick at one time formed less than six per
cent, of the whole force, and never exceeded eight per cent.
These ratios are much less than ever before met with in an
army of such a size engaged in active operations. In the
English and French armies in the Crimea the proportion
was far greater than this, and even in camps established
during peace, and with every opportunity of paying especial
attention to sanitary measures, a more favorable condition
has rarely been presented.

462 A TREATISE ON HYGIENE.

CHAPTER XXI.

FOOD.

As a necessity of existence, food is only second in im-
portance to atmospheric air. A few moments deprivation
of one or a few days of the other produces death. The
tissues require renovation, and the heat of the body must
be maintained. For these two objects food is taken.
These only are the physiological uses. Another incentive
to the ingestion of food, the gratification of the sense of
taste, is mainly the result of civilization. When we eat to
preserve life, it rarely happens that disease is the conse-
quence; but when the indulgence of the appetite is based
on sensual gratification, disorder of almost every function
of the body may be produced, and even structural altera-
tions of organs may in time result. It thus happens that
from yielding to the temptation to eat more than the sys-
tem requires to maintain it in healthy action, or of those
things which experience has shown to be injurious, man is
more subject to disease through the influence of food than
from any other cause.

The essential qualities of food are, first, that it shall con-
tain those substances which are capable of nourishing the
tissues or of entering into such combinations as will result
in the production of heat; and second, that the nutritious
material shall be in such a form as will admit of its being
digested and assimilated by the organs whose office it is to
prepare the ingesta for the purposes of the organism.
There are many substances which are easily digested but
yet do not possess such a composition as to render them

FOOD.

463

useful to the system, either as histogenetic or heat-pro-
ducing materials; and, on the other hand, others, which if
we regarded them simply from the stand-point of their
composition, would be pronounced as highly nutritious, or
as excellent calorifacients, but which experiment has de-
monstrated are absolutely useless as food, from the fact
that they are incapable of being acted upon by the diges-
tive juices. To this last class belongs gum, a substance
analogous in composition to starch and sugar, both useful
articles of food ; yet gum when ingested into the stomach
undergoes no change in the alimentary canal, but is ex-
creted in the same form as it possessed before its entrance
into the body. The experiments of Boussingault, Frerichs,
Bondlot, Lehmann, and myself* are perfectly conclusive
on this point.

Under the head of food are included not only the sub-
stances which are eaten, but also those which are drunk.
Liquids are as much entitled to be considered food as are
the various solid substances to which the designation is
ordinarily restricted.

The most natural division of food would be into animal,
vegetable, and mineral, for all three kingdoms unite to fur-
nish man with his sustenance. In cold climates he lives
almost entirely on animal and mineral food, in hot ones on
vegetable and mineral substances, in temperate climates
he draws his food from the animal and vegetable kingdoms
of nature, and mixes with it a due proportion of inorganic
matter. Thus we may regard the mineral substances —
under which head water, salt, iron, etc. are to be included
as the most generally necessary for the maintenance of

life.

But such a classification is not that which affords us the
clearest ideas relative to the character of the food of man.

* Physiological Memoirs, p. 137.

4G4 A TREATISE ON" HYGIENE.

It gives us no indications in regard to the composition of
the substances which constitute his diet, or of the purposes
which they serve in the economy, and therefore a more
philosophical division, based upon chemistry, is necessary.
We know that no two articles of food are exactly alike,
either in composition or in their effects upon the system;
but it has been ascertained that the several alimentary
substances can be arranged in groups, the members of
which fulfil analogous uses in the economy, and which
possess some one or more striking features in common.

It is extremely difficult to make any classification of the
substances taken as food which is not open to objection.
It has been attempted on the basis of their supposed physi-
ological destination, and thus they were divided into the
histogenetic and the calorifacient substances; the one
going, as was imagined, solely to the formation of tissue,
and the other entirely to maintain the heat of the body.
More extended observation has, however, shown that no
such exclusive division exists, as those substances which
are pre-eminently tissue forming also aid in producing heat,
and those which are mainly calorifacient in their action
likewise contribute to the formation of tissue.

It is important that this division, which, through the in-
fluence of Liebig and his followers, has become familiar to
most well-read persons, both in and out of the medical pro-
fession, should be altogether set aside as one that is calcu-
lated to lead to very erroneous theories and practices. If
there is any one substance which is pre-eminently tissue
forming it is albumen, and yet, as I have shown by posi-
tive experiment, it is entirely possible not only to form
tissue with this substance alone, but also to maintain the
animal heat at its normal standard, no other article of food
being taken into the system except water. On the other
hand, fat is, from its composition, one of the most powerful
agents in the production of animal heat; but, as observa-

food. 465

tion shows, fat is essential to the formation of the primary
cells from which all tissues result.

A more convenient classification is based upon the pre-
dominance in the substances in question of some one or
more elements which give an individuality to the group of
articles in which they are found. This division, which
was that proposed by the author* several years since,
although by no means perfect, is, all things considered, the
most available for our present purpose. In accordance
with it there are —

1st. The nitrogenous substances, characterized by the
presence of nitrogen, such as albumen, musculin, casein,
gluten, etc., which principally are of use in forming tissue,
but which also aid in sustaining the heat of the body.

2d. The fats, composed of carbon, hydrogen, and oxygen,
the carbon being in larger proportion and the hydrogen in
excess of the quantity required to unite with the oxygen to
form water. These substances are pre-eminently calorifa-
cient, but are essential to the formation of tissue. They
are sometimes called hydrocarbons.

3d. The amylaceous and saccharine groups or carbohy-
drates, which are also composed of carbon, hydrogen, and
oxygen, the two latter, however, being present in the propor-
tion necessary to form water. The substances of these groups
are also mainly useful for the production of heat, but like-
wise enter into the composition of some of the tissues.

4th. Inorganic substances, such as water and certain
minerals.

5th. Substances which, perhaps, strictly speaking, are not
food, such as alcoholic liquors, coffee, tea, spices, etc., but
which are of service either as promoters of digestion, as

* On the Nutritive Value and Physiological Effects of Albumen,
Starch, and Gum, when singly and exclusively used as Food. Prize
Essay of American Medical Association, 1856. Also Physiological
Memoirs, p. G8.

466 A TREATISE ON HYGIENE.

retarding the too rapid waste of the tissues, or as tending
to increase the heat of the body, either by their own oxida-
tion or by their peculiar action on the nervous system.
These articles have been designated "accessory food/' a
term which very well expresses their functions in the
economy.

All the alimentary substances used by man as food are
comprised within the above-named groups. We shall there-
fore consider the ingesta under the five heads specified,
namely, the nitrogenous aliments, the fatty aliments, the
amylaceous and saccharine aliments, the inorganic aliments,
and the accessory aliments. But in so doing, it would not
altogether answer the purpose we have in view if we should
stop here. It is important that the nutritive value of the
various articles of food, as they are used by man, should be
understood. Thus many substances are compound, to the
composition of which two or more of the above-named classes
contribute. Bread, for instance, is nitrogenous, amylaceous,
and inorganic. Indian-corn contains, in addition, a large
amount of oil; and all the nitrogenous articles of food have
mineral substances as essential constituents. After the con-
sideration of the elementary groups, into which we have
divided the ingesta, we shall therefore point out the physio-
logical and hygienic relations of the more important com-
pound articles of food which are used by man, the adulter-
ations to which they are subjected, the means by which
their purity can be ascertained, and the proper methods to
employ in cooking and otherwise preparing them to be
eaten.

ALIMENTARY PRINCIPLES. 467

CHAPTER XXII.

ALIMENTARY PRINCIPLES.

The alimentary principles are those which, as has been
said, give rise, by their union, to the various substances
which are used as food. It does not often happen that they
are ingested in their uncombined form, as they are neither
in such a condition generally palatable nor in the best state
to be acted upon by the digestive juices. Nature has so
mingled them as to adapt them to the taste and render
them better fitted for the purposes of life; and man, as if
by instinct, mixes them so as to form compound substances
capable of fulfilling the requirements necessary in food.
But by pointing out the peculiarities of the several aliment-
ary principles, we shall be better enabled to form a correct
opinion relative to the compound substances into the con-
stitution of which they enter.

The Nitrogenous Alimentary Principles. — As denoted
by the name, the aliments of this division are those which
contain nitrogen. Several principles have been distin-
guished by chemists as belonging to this class, but they
can all be reduced to three — albumen, casein, and gluten
— and they are found both in the animal and vegetable
kingdoms. Thus, for example, emulsin is identical with
the albumen of animal tissues, legumin with casein, and
fibrin with gluten. In addition to nitrogen, they contain
carbon, hydrogen, and oxygen, together with small quanti-
ties of sulphur and phosphorus. Mulder suggested that
they were all modifications of a common principle, protein ;
but the existence of this body has never been satisfactorily

468 A TREATISE ON HYGIENE.

established, though the theory has given the designation of
proteinaceous to the substances in question.

The nitrogenous principles differ from those of the other
classes, in the fact that they undergo putrefaction when
subjected to certain conditions. By this process they are
resolved into carbonic acid, ammonia, water, and compounds
of sulphur, phosphorus, and hydrogen, characterized by the
offensiveness of their odors and by the deleterious effects
which they are capable of producing on human health.

In order that putrefactive decomposition shall occur, an
elevated but not too high a temperature is necessary. At 32°
the process is altogether prevented, and at points above
100° the substance rapidly becomes dry through the loss of
its water, and, in the condition which results, may be indefi-
nitely preserved. Advantage is taken of both these facts
to preserve articles of food. Meats of various kinds are
frozen, and can then be transported to any distance and
kept for any length of time. South-down mutton is brought
from England to New York without the loss of any of its
good qualities.

In the western prairies buffalo meat is cut into thin strips
by the Indians and emigrants, and exposed to the full heat
of the sun for several days. After it is thoroughly dried it
may be kept for any length of time without undergoing
putrefaction, if it is preserved from the influence of moisture.
Bread can also be kept, when deprived of the greater part
of its water by being exposed in an oven to a high heat.
Crackers and hard bread are prepared in this way.

It is thus seen that moisture is also essential to putrefac-
tion. All the nitrogenous substances used as food can
be readily kept for years if they are deprived of their
water.

Putrefaction is prevented by excluding the substance
from the action of the atmosphere. This fact is taken
advantage of in the preservation of articles of food in

ALIMENTARY PRINCIPLES. 469

hermetically sealed cans. Meats, milk, fruits, etc. are thus
kept sweet for years.

Putrefaction can also be prevented by the addition of
sulphite of lime or soda to any fluid nitrogenous substance
which it is desirable to preserve. A few grains of either
salt, not sufficient to be detected by the taste, will arrest
decomposition. The first act in putrefaction is the libera-
tion of oxygen, which seizes on a portion of the sulphite
and converts it into a sulphate. So long as any sulphite
remains unchanged, the substance will be preserved from
putrefaction.

Salt, sugar, corrosive sublimate, arsenic, chloride of zinc,
chloroform, alcohol, spices, and many other substances pre-
vent putrefaction, mainly by coagulating the albumen and
abstracting the water from it. We shall remark further
upon the methods of preserving food in subsequent chap-
ters.

The nitrogenous principles admit of easy digestion and
assimilation, from the fact that they require little alteration
to be converted into tissue. Though they differ in physical
characteristics and apparently in chemical constitution, it
is probable that they are, as asserted by Mulder, essentially
one substance.

I have not included gelatin among the nitrogenous prin-
ciples, for the reason that, though containing nitrogen, it is
not an original formation, being derived from certain animal
tissues by the action of boiling water. It is produced under
various forms, according to the character of the substance
acted upon. When taken as food it is at once excreted by
the kidneys, having undergone decomposition, and appear-
ing as urea. It does not contain either sulphur or phos-
phorus.

The protein bodies are readily detected by Millon's test,
which consists of a solution of mercury, formed by dissolv-
ing one part of pure quicksilver in two of nitric acid of 1*41

470 A TREATISE ON HYGIENE.

specific gravity. On adding this solution to any fluid sus-
pected to contain a proteinaceous substance, and raising
the temperature to from 140° to 212°, a bright-red color is
produced. Gelatin causes the same reaction.

Albumen, the most important of the nitrogenous aliment-
ary principles, occurs both in the animal and vegetable
kingdoms. It is found in flesh as musculin, in the blood
as seralbumen or globulin, in the egg as ovalbumen, and in
the vegetable kingdom as emulsin. It is also met with
under other names, which it is scarcely necessary to allude
to further, as they will be found fully considered in the
several treatises on physiological chemistry.*

Albumen is devoid of taste or odor; it is coagulated by a
temperature of 1454° Fahrenheit, forming a white elastic
substance insoluble in water. When taken into the stom-
ach, albumen is at once coagulated by the gastric juice, and
hence the generally received opinion, that soft-boiled eggs,
or those in which the albumen is not coagulated, are more
easily digested than those which are hard boiled, is erro-
neous.

It is a most important article of food, both from the facil-
ity with which it is digested and its value as a tissue-forming
substance. In a series of investigations-)- which I instituted
upon myself several years since, I showed that the animal
temperature could be maintained on a diet consisting only
of albumen and water. I found, as the mean of ten days'
exclusive use of albumen, that enough was daily absorbed
to yield 4216 grains of carbon to the system.

Casein is also a constituent of animal and vegetable sub-
stances. It exists in great abundance in milk, from which
it may readily be obtained by raising the temperature to

* The student is referred to Dr. Day's Chemistry, in its Relations to
Physiology and Medicine, as the best work on the subject adapted to
his wants.

f Physiological Memoirs, p. 84.

ALIMENTARY PRINCIPLES. 471

about 150° Fahrenheit and stirring in a few drops of acetic
acid. The raucous membrane of the stomach of the calf or
its infusion also possesses the power of separating it. It is
likewise separated spontaneously by the fermentation which
milk undergoes, and the consequent formation of lactic acid,
which coagulates the casein.

The casein of vegetable substances is called Ugumin, and
is found in great abundance in peas and beans.

Casein exists in the milk of all animals, in the blood,
in the yolk of the egg, (vitellin,) and other tissues. It is
not coagulated by heat, in which respect it differs from
albumen, and is precipitated by lactic and acetic acid from
its solutions. When taken into the stomach it is at once
coagulated.

Casein is exceedingly nutritious. Coagulated and pressed,

to remove the whey, it constitutes cheese, a wholesome ar-

'ticle of food, if used f before it has become old and undergone

those putrefactive changes which, though they add to its

flavor, render it indigestible and irritating.

Gluten. — If the dough of wheat flour be washed in a
stream of water, the starch, sugar, gum, and soluble matter
are removed, and a thick, tenacious, and opaque substance
(gluten) remains. It is insoluble in water, but dissolves in
acetic acid and in the gastric juice.

Wheat flour contains about 12 per cent, of gluten, to
which substance it owes the principal part of its tissue-
forming property. It is easy of digestion. Macaroni con-
sists in great part of this substance.

Fibrin is the analogue of gluten in the animal kingdom.
It is found in the blood in a state of solution, probably
owing to the presence of ammonia, but coagulates, under
ordinary circumstances, as soon as the blood is removed
from the body. It may be obtained in the form of white
shreds by agitating freshly-drawn blood with strips of lead.

The Fats or Hydrocarbons. — The fats are met with

472 A TREATISE ON HYGIENE.

both in the animal and vegetable kingdoms, and both in
the liquid and solid form. They differ in composition, but
consist of olein, stearin, and margarin in variable propor-
tions. These substances are compounds of oleic, stearic,
and margaric acids with glycerin. Certain volatile acids
are also present in fats and oils.

The composition of the fats is such that they exert great
influence in the production of the animal heat. As we
have seen, therefore, they constitute a great portion of the
food ingested by the inhabitants of the arctic and antarctic
regions. Within the system they undergo oxidation, with
the consequent production of carbonic acid and water, a
process which is strictly analogous in its effects and its
results to the combustion of oil in a lamp or the burning of
a candle.

Fat is also essential to the metamorphoses which are
constantly going on in the animal body, the nitrogenous
aliments being incapable of undergoing solution and diges-
tion in the stomach unless fat is present.

Fat is found in all animals except a few of the lower
orders. To man and the higher animals it acts as a non-
conductor of heat, and mechanically is useful by serving to
protect parts from pressure which would otherwise, from
their situation, be liable to injury on this account.

The fats are insoluble in water, but are dissolved to a
greater or less extent by alcohol and ether. They are
digested by being converted into an emulsion through the
action of the pancreatic juice, and thus, being divided into
small particles, are capable of being absorbed.

The Amylaceous and Saccharine Principles. — The
substances of this class which are used as food are starch,
sugar, and gum, of each of which several modified forms
exist, but which do not vary essentially from each other.
Even the groups themselves present but little difference in
composition, all containing twelve atoms of carbon united

ALIMENTARY PRINCIPLES. 473

to hydrogen and oxygen, which" are present in the propor-
tions necessary to form water.

Starch is principally found in the vegetable kingdom,
being present in many plants in the form of granules,
which are easily recognized, though very variable in form
and size. It is obtained by bruising the substance in
which it exists and washing with water till the soluble
matter and gluten are separated. The starch being in-
soluble in water is readily collected.

Starch is insoluble in cold water, from the fact that each
granule is inclosed in a membranous envelope which resists
the action of this menstruum. When hot water is used,
the envelope bursts, and the starch, escaping, is dissolved
in the water. Chemically, starch is recognized by iodine,
which gives a blue or purple color to solutions or mixtures
containing it.

Starch is also found in animal tissues under various
forms, which, though microscopically presenting different
appearances, possess the same chemical reactions, and
appear to have the same composition.

The principal use of starch in the economy is as a heat-
producing agent. From its easy digestibility, its influence
in this respect is very great, and it is even superior to some
of the fatty substances which, if we judged solely from
their chemical composition, would appear to be more valu-
able. Boussingault* fed a duck solely upon bacon, and
found that enough was not assimilated in a given time
to repair the loss through the respiratory process, while
another duck, fed upon starch, absorbed nearly twice as
much as was sufficient to furnish carbon for the wants of
the system. My own experiments-)* also show that in tem-
perate climates at least, sufficient starch can be assimilated
to maintain both the heat and weight of the body.

* Memoires de Chimie Agricole et de Physiologie, p. 220.
f Physiological Memoirs, p. 112.

474 A TREATISE ON" HYGIENE.

Starch, by the action of the saliva, is converted into
sugar. The same change is effected by the intestinal juice.
It is only under this last-named form that it is absorbed
into the blood.

Although starch is found in the animal organism, by far
its principal source is the vegetable kingdom. The several
grains used as food, with most of the other vegetables, con-
tain it in large quantity, and under the forms of arrow-
root, tapioca, sago, tous-les-mois, and many other varieties,
it constitutes an important and useful article of food. As
neither of these substances can be considered as compound
articles of food, it will be proper to consider them in
detail in the present chapter.

Arrow-root, — Arrow-root is starch obtained from the
tuberous roots of the Maranta arundinacea. The roots are
washed, and squeezed or beaten into a pulp with water, so
as to separate the starch from the fibrous portion. The
former remains suspended in the water, from which it is
deposited on standing.

The plant from which arrow-root is derived grows in the
East and West Indies, in the southern part of Africa, and
in Georgia and Florida. That which comes from Bermuda
is esteemed as the purest and best.

Arrow-root, as found in the market, consists of a pure,
white powder, which, when pressed between the fingers,
produces a crackling sound. It is the purest form in which
starch is found in commerce. As an article of diet for the
sick and for children it is very valuable, on account of its
unirritating properties, and when boiled with milk an ali-
ment is obtained which fulfils all the requirements of the
system. When it is prepared with water its nutritious
qualities are much lessened, as then it is incapable of form-
ing tissue. In certain low conditions, in which it is of
more importance to provide for the continuance of the
respiratory process and the maintenance of the animal

ALIMENTARY PRINCIPLES. 475

temperature than the formation of tissue, arrow-root and
water constitute a very useful article of diet, and one
which is easy of digestion, as the residue to be excreted as
feces is almost nothing.

In typhus and typhoid fevers, and in inflammatory affec-
tions of the stomach and bowels, arrow-root may be very
advantageously employed.

The best way of preparing arrow-root for internal ad-
ministration is to mix a tablespoonful into a thin paste
with cold water and to add gradually a pint of boiling
water or milk, stirring the mixture continually during the
process. Part milk and part water may be used if con-
sidered desirable. In this way a smooth, uniform, gela-
tinous solution is obtained, which may be sweetened before
being ingested. Wine and spices may also at times be
added. On cooling, such a solution becomes of a semi-solid
consistence, and if a sufficient amount of arrow-root has
been used with milk a very palatable hlanc-mange is
formed, which is not only grateful to the taste of the sick,
but is also highly nutritious.

From the high price which it ordinarily commands,
arrow-root has always been subject to extensive adultera-
tion. To such an extent has this been carried, and so
inferior was the article in the market, that at the last re-
vision of the army medical supply table its place was
supplied by corn starch, which is an excellent substitute,
and altogether free from the irritating qualities of the
potato starch, with which arrow-root is generally sophisti-
cated. Corn starch can always be obtained pure, and is
much less expensive than arrow-root. While it is not so
desirable in every respect as the pure arrow-root, it is far
better than the ordinary commercial article with which
the market is supplied.

For the detection of the impurities of arrow-root, the
microscope affords the most ready and effectual means.

476 A TREATISE ON HYGIENE.

In fact, chemistry gives no tests which are at all reliable.
The muriatic acid test is altogether worthless, as I have
ascertained, by trial.

In order to be able to apply the microscope effectually
to the examination of arrow-root, it is of course necessary
to be thoroughly acquainted with its microscopical charac-
teristics. Starch granules of all kinds possess certain
features in common, but a careful examination of them
enables a correct discrimination to be made between them.

A small portion of this or any other form of starch
which it may be desirable to examine microscopically is
mixed with a little cold water, and a thin layer spread on
a glass slide. If too thickly spread, a drop or two of water
may be added. It is covered with a piece of thin glass,
and is ready for examination.

The starch granules of the maranta arrow-root vary in
length from the 2000th to the 800th of an inch, and in
width from the 3500th to the 1200th. In form they are
irregularly ovoidal, one extremity being generally more
rounded than the other, giving them very much the ap-
pearance of small oysters. The hilum is situated at one
extremity, generally the more pointed one, and is well
marked; a dark line extends from it transversely on each
side. Sometimes, however, there are radiating lines, and
occasionally none at all. No other form of starch granule
has such a hilum, and after it is once recognized a distinc-
tive characteristic is obtained. Numerous concentric lines
surround it.

The granules of potato starch, with which arrow-root is
generally adulterated, are much less uniform in size, rang-
ing from the 4000th to the 250th of an inch in their long
diameter, and thus a good indication is obtained, as the
granules of arrow-root are never as large and rarely as
small as this.

Tapioca is obtained from the root of the Janipha manihot,

ALIMENTARY PRINCIPLES. 477

a poisonous plant growing in Brazil and other parts of
tropical South America. It is also found in the West
Indies, where it is called the cassava tree. Two other
species of the same plant, which are devoid of poisonous
properties, also yield tapioca. The root, which is tuberous,
is large, and contains a quantity of a milky juice, which
owes its white appearance to the starch which it holds in
suspension. The root is bruised, and made into a pulp
with water. It is then subjected to pressure, by which
the juice is made to exude. The powder which is de-
posited from it is washed, and dried by exposure to artifi-
cial heat, by which process the envelope of the starch
granule is ruptured. In this form it constitutes the tap-
ioca of commerce, and is met with as irregularly-shaped
grains, of a white color, and varying in size from the 24th
to the 4th of an inch. The poisonous principle, a portion
of which is pressed out with the juice, is entirely dissipated
by the heat to which the powder is subjected. The root
which remains is also heated, to volatilize the deleterious
substance, and is then made into bread or cakes.

Owing to the rupture of the membrane surrounding the
starch granule, tapioca is, to some extent, soluble in cold
water. It is unirritating to the bowels, and, according to
Dr. Christison, is less liable to turn sour, during digestion,
than any other form of starch. According to my experi-
ence it is no better in this respect than arrow-root or corn
starch. It forms a more consistent jelly than the former
substance, and presents some peculiarities of taste and
appearance which render it a desirable article of food for
the sick. It should be well boiled before being ingested.
A tablespoonful may. be stirred into a pint of warm water
and allowed to macerate for half an hour. It is then to
be well boiled for ten or fifteen minutes. Milk or water
may be used as the solvent, and sugar, spices, and wine
added as occasion may require. With eggs and milk a

478 A TREATISE ON" HYGIENE.

very nutritious and palatable pudding is made. Tapioca
may be substituted for arrow-root in all diseases in which
the former is useful.

The adulteration of tapioca is not carried to any very
great extent in this country. The microscope readily de-
tects any sophistication, as the granules of this variety of
starch are, owing to natural characteristics and the altera-
tion which they have undergone by the heat to which they
have been subjected, readily distinguished from those of
other kinds of starch. The hilum and concentric lines are
obliterated, and the granules are found split into two or
more fragments. Pieces of the enveloping membrane are
also to be seen. In their natural state the granules are
small, being about the 2000th of an inch in diameter, and
of a rounded form. The hilum is distinct, and surrounded
by concentric rings. As found in commerce, both the
natural and altered granules are present, the latter pre-
dominating.

Sago is prepared from the pith of several species of Sagus,
a tree belonging to the order Palmaceae, inhabiting the East
Indies. The stem of the tree is broken into fine pieces
and mixed with water. The mixture is strained, by which
process the woody fiber is separated. The water contain-
ing the starch is then removed by evaporation, and the
farina is left behind. This is subsequently rubbed into a
paste with water, and moulded into small round grains
about the size of the head of a pin, in which state only it
is found in the market in this country.

Sago is only slightly soluble in cold water, and requires
long-continued boiling to dissolve in hot water. As ordi-
narily cooked, the grains can be readily distinguished.

The starch granules of sago, as they are seen in sago
meal, a preparation which is imported into England, are
oblong, rounded at one end, and generally square at the
other. The hilum is circular when perfect, but is often

ALIMENTARY PRINCIPLES. 479

cracked in the form of a star, cross, or slit. The concentric
rings are not so distinctly marked as in other varieties.
The granules are, in the mean, fully twice the size of those
of arrow-root. In the pearl sago the process which it has
undergone in the preparation of the grains has destroyed
the characteristic features of the granules. The hilum is
obliterated, but the concentric lines are still indistinctly
visible. The size of the granules is unchanged.

Sago is adulterated with potato starch, the granules of
which admit of easy detection with the microscope.

As an article of food for the sick, sago is very excellent,
provided it be well cooked; otherwise, the grains not being
thoroughly broken up, the starch granules would many of
them remain undissolved, and might give rise to intestinal
irritation. A tablespoonful to a pint of water or milk
makes a mixture less consistent than other forms of starch,
and is extremely unirritating. It should boil for fifteen or
twenty minutes, being well stirred during the process to
prevent scorching and to insure the perfect solution of the
granules. It should then be strained, in order to separate
any masses not thoroughly dissolved. Spices, sugar, and
wine may be added if not contraindicated.

Corn starch is an admirable substitute for arrow-root, is
fully as unirritating, and can always, in this country, be
obtained pure and in any quantity that may be required.
It is prepared from Indian-corn by bruising and washing
the grains, and allowing the starch to subside from the
water in which it is suspended. Its cheapness prevents its
adulteration.

As an article of food it is prepared in the same way as
arrow-root, but as it forms a firmer jelly so much of it need
not be used. It makes a very excellent blanc-mange, and
with eggs and milk very good puddings.

Potato starch is not well adapted for use as an article of
food, on account of the tendency it possesses to produce

480 A TREATISE ON HYGIENE.

irritation of the stomach and intestines. It is extensively
used to adulterate the other more costly kinds of starch.
Its microscopical characteristics will sufficiently distinguish
it from any other varieties.

Tous-les-mois. — This variety of starch is prepared from
the root of a species of Canna, probably the Canna coccinea,
a plant growing in the West India Islands.

Canna starch is a fine white powder, and can readily be
distinguished microscopically from any other form of starch,
on account of the large size of its granules. The hilum is
round and is situated at the small extremity of the granule.
The concentric rings are very close together and more regu-
larly arranged than in other varieties.

Canna forms a thick jelly after being boiled in water and
suffered to cool, which is a very advantageous article of diet
for the sick or convalescent. It is prepared for food in the
same way as arrow-root.

There are other forms of starch to which attention might
be directed, but they possess no peculiarities worthy of spe-
cial mention. Oatmeal, rice flour, barley, etc., though con-
stituted in great part of starch, contain other substances
which make them compound articles of food.

Sugar. — Sugar occurs principally under two forms — cane
sugar and grape sugar. Other saccharine principles exist,
but as they are not used as food, their consideration need
not detain us. In composition both forms are analogous to
starch, differing only in the number of hydrogen and oxygen
atoms.

Cane sugar is principally obtained from the sugar cane, a
plant growing in tropical countries throughout the world,
but is also derived from the beet and the sugar maple.
Beet sugar is manufactured in large quantity in France
and Germany, and maple sugar in the United States and
Canada. It is likewise obtained from the Chinese su2;ar
cane, though the greater part of the saccharine principle
of this plant is grape sugar.

ALIMENTARY PRINCIPLES. 481

From all these plants sugar is prepared by evaporating
the expressed juice, or, as in the case of the sugar maple,
the sap, as it is collected in the spring. The evaporation
is carried on until the sugar granulates, when the syrup is
drawn off. As thus prepared, sugar is in dark-yellow grains
or in compact cakes, according to the degree of concentra-
tion which has been reached. White sugar is made by
subjecting the impure brown sugar to refining processes.

Grape sugar is uncrystallizable, differing in this respect
from cane sugar. It is found in fruits, in the Chinese sugar
cane, and is the sugar which is present in the urine in dia-
betes, and is formed from the action of the digestive juices
on starch and cane sugar. It is not so sweet as cane sugar,
two parts of the latter being equal in this respect to five of
the former.

As an article of diet sugar of either form is rarely if ever
used, except as an adjunct to some other food. Its physio-
logical properties cannot be very different from those of
starch, owing to the similarity of composition, and, as we
have seen, starch is converted into sugar before assimi-
lation.

Sugar is by no means unwholesome, but, on the contrary,
is excellent as a respiratory article of food. As is well
known, the laborers who extract it from the plants in which
it exists eat it in large quantities, and find in it a nutri-
tious and agreeable substance. The negroes of Louisiana,
employed on the sugar plantations during the sugar season,
eat it in enormous quantities, and grow fat under its use.
It is also very fattening to domestic animals.

In disordered conditions of the stomach, sugar should not
be ingested, as it is, under such circumstances, apt to un-
dergo fermentation with the consequent production of car-
bonic acid and alcohol. A solution of pure cane sugar in
water does not ferment, the only change which takes place
being its conversion, by a slow process, into grape sugar.

482 A TREATISE ON H7GIENE.

Within the system this change does not ordinarily take
place, for the reason that the saccharine matter is digested
before there is time for it to be initiated; but when there
is a torpid condition of the digestive organs, the sugar, or
the substances in which it exists, remains in the stomach
sufficiently long for the nitrogenous matters present to set
up the fermentative action.

Besides converting starch into sugar, the intestinal juice
exercises the further action of converting sugar into lactic
acid, and it is probable that, if the contact is maintained
sufficiently long, the gastric juice will effect the same
change. Under its influence cane sugar is certainly trans-
formed into grape sugar, as I have ascertained by experi-
ment. The same fact was determined by MM. Bouchardat
and Sandras* several years since, but has been denied by
other investigators. That the lactic acid fermentation can
also take place in the stomach under certain circumstances,
giving rise to heartburn, water-brash, and other symptoms
of dyspepsia, is, I think, very certain. MM. Fremy and
Boutronf ascertained that solutions of sugar were trans-
formed into lactic acid under the influence of certain putre-
fying nitrogenous substances, such as cheese and others
which enter into the composition of the food. M. Pasteur,J
who has given very great attention to this and allied sub-
jects, has shown that the change is not due to putrefaction,
but to the presence of innumerable and very small infusoria
or animalcules. These little beings appear to possess the
power of inducing the lactic acid fermentation, just as the
yeast-plant or torula cerevisiw causes the alcoholic fermenta-

* De la Digestion des Matieres feculents et sucrees, etc. Supplement
a l'Annuaire de Therapeutique, 1846, p. 83.

f Recherches sur la Fermentation lactique. Ann. de Chimie, 1841,
tome ii. p. 257.

% Memoir sur la Fermentation appelee lactique. Ann. de Chimie, 1858,
tome lii. p. 404. Also Coraptes Kendus, 1860, tome 1 p. 849.

ALIMENTARY PRINCIPLES. 483

tion. It is very easy to prove the presence of these organ-
isms. A solution of sugar is mixed with a little cheese and
exposed to the atmosphere, at a temperature of from 80° to
90° Fahrenheit. In a few hours, upon examining a drop
of it microscopically, myriads of these infusoria will be
found to have made their appearance, and lactic acid will
have been developed. Gluten and the flesh of animals will
cause the same formations, but not with the same rapidity
as cheese. It is probably owing to this property of casein,
of which a large quantity is ingested by children in milk,
that in them the lactic acid fermentation is so readily
induced. Sugar is therefore more apt to cause intestinal
disturbance in children than in grown persons, though even
in these latter, as has been said, if gastric digestion is de-
layed, the lactic acid fermentation is liable to be estab-
lished.

Sugar is not of itself capable of supporting life for any
considerable length of time. Magendie* found that dogs
fed on pure sugar died from defective nutrition. Thus one
of these animals was fed exclusively upon pure sugar and
water. For the first seven or eight days it appeared to
thrive, was lively, and seemed to relish its food. Soon
afterward it commenced to lose flesh, though its appetite
was still good, and eventually it became very feeble, an
ulcer appearing on each cornea, through the perforation
caused by which the humors of the eye escaped. On the
thirty-second day, the animal, very much emaciated, died.
Similar results were obtained by Tiedemann and Gmelin,f
and my own unpublished experiments also show that sugar
alone is not capable of sustaining life.

But, though this is the case, the beneficial effects of sugar

* Physiologie, tome ii. p. 390; and Ann. de Chimie et de Phys., tome
iii. p. 66.

f Recherches Experimentales Physiologiques et Chimiques sur la Diges-
tions, etc. Paris, 1827, seconde partie, p. 218.

484 A TREATISE ON HYGIENE.

cannot be denied. Its composition shows it to be a good
respiratory food, and there is no doubt in regard to its con-
version into fat. I have known several persons who be-
came corpulent from no other cause, as far as could be
ascertained, than from the ingestion of large quantities
of sugar. It cannot, however, of itself produce any of the
animal tissues except fat, for the reason that it is devoid of
nitrogen; and hence, in animals fed entirely on it, the waste
of the muscles and other organs is not supplied. If there
was an absorption by the lungs of nitrogen from the atmos-
phere, this difficulty might be obviated; but, on the con-
trary, nitrogen is excreted in respiration instead of being
taken into the system. The instances of insects feeding
entirely on sugar are not valid, as they eat brown inferior
sugars, which always contain nitrogenous matters. Insects
cannot maintain life on pure white sugar much longer than
they can exist on no food at all.

The moderate use of sugar as an article of food is not,
therefore, to be condemned; on the contrary, its presence
in milk is sufficient to prove its usefulness, and the instinct
which children show for it is certainly entitled to be re-
garded as an indication of its value. For the sick it is
generally a grateful addition to those amylaceous and nitro-
genous mixtures, such as arrow-root, sago, tapioca, etc., with
milk and eggs, which I have never seen do harm, except in
certain kinds of dyspepsia. The generally received view,
that sugar is productive of decay of the teeth, is altogether
without the least proof to sustain it; on the contrary, it is
an excellent preservative for all animal tissues. If it comes
in contact with the exposed nerve of a tooth, it causes
toothache, which fact is doubtless the origin of the above-
mentioned idea.

The antiseptic properties of sugar render it of much value
as a preservative of certain articles of food, which other-
wise could not be kept more than a few days without spoil-

ALIMENTARY PRINCIPLES. 485

ing. Fruits of various kinds are thus, by being cooked with
sugar and surrounded with syrup, preserved for years, and
constitute agreeable and nutritious alimentary substances.
It is also an excellent adjunct in the preservation of ham
and beef, improving the flavor and lessening the tendency
to putrefaction.

Sugar is subject to adulteration with starch, chalk, sul-
phate of lime, and sand. As all of these substances are
insoluble in water their detection becomes very easy. The
microscope will also reveal their presence. I have met with
several samples of powdered white sugar which were adul-
terated with starch, and one in which a considerable quan-
tity of chalk was present. If this substance is employed
as the adulterating agent, the residue insoluble in water
will dissolve with effervescence in any strong acid.

Grape sugar, which is extensively manufactured from
potato starch, is also used in the adulteration of cane sugar.
As it is not half so sweet as the latter, its detection is a
matter of importance. This is readily accomplished by
means of Trommer's test, which depends upon the fact that
the oxide of copper is reduced to the form of the suboxide
by grape sugar and not by cane sugar. To a solution of
sugar a few drops of a solution of sulphate of copper are
added, and then a small quantity of solution of caustic
potash. The mixture is now boiled in a test tube. If
dextrine be present, the solution becomes of an olive-green
color, and if grape sugar, the oxide of copper which has
formed is reduced to the orange-colored suboxide, which
gives its hue to the whole mixture.

Brown sugar is generally full of impurities, consisting of
fragments of sugar cane, gum, a peculiar nitrogenous mat-
ter, silica, salts of lime and potash, the spores of the sugar
fungus, and a species of acarus or mite. Owing to the pres-
ence of these substances, brown sugar should not be used
for the sick, and preferably not by healthy persons.

486 A TREATISE ON HYGIENE.

By dissolving brown sugar in water it will be seen that
the proportion of insoluble impurities present is quite large.
The greater part consists of minute fragments of sugar cane,
which are only distinguishable with the microscope. In the
sediment the spores of the fungus, consisting of small ovoid
bodies, often united so as to form beaded branches, are seen;
and it is here that the acari can generally be collected.
The acarus sacchari belongs to the same genus as the itch
insect, and in my examinations of many samples of the
coarsest brown sugars I have never failed to find it. Has-
sall* expresses the opinion that the grocer's itch, a disease
of the skin, attended with itching and the formation of
little pustules, is caused by this sugar mite, just as the
acarus scabei produces the true itch. This is, I think, very
plausible.

Under the head of sugar it will be proper to mention mo-
lasses, a substance which, though not pure sugar, scarcely
admits of consideration elsewhere. It consists of the un-
crystallizable portion of the juice of the cane, the maple,
and the Chinese cane, which is united to gummy and color-
ing matters, dissolved in water. It is met with in com-
merce as West India molasses, which is of a black color,
has the odor of rum, and is used in the manufacture of this
liquor; and as sugar-house molasses, which is thicker and of
a different flavor. Refined, and the extraneous matters
thus removed, molasses is converted into a golden-yellow
syrup, possessing less sweetness than the crude molasses,
and on many accounts less desirable as an article of food.

Molasses is issued to the troops of the United States army
whenever the medical officers certify to its necessity, and
is in regular use in the army hospitals. It is an agreeable
and nutritious aliment, and is supposed to possess antiscor-
butic virtues. Whether it has any direct power against

* Adulterations Detected, etc. London, 1857, p. 193.

ALIMENTAR7 PRINCIPLES. 487

scurvy or not, no doubt can exist relative to its good effects
after the men have been subjected for some time to a uni-
form diet, as may be the case in the field and on the
frontier.

Gum. — As an article of food gum is entitled to a very
low rank, not so much on account of its composition, as it
is very similar in this respect to starch and sugar, but be-
cause it is not capable of being so acted upon by the digest-
ive juices as to be brought into a form fit for assimilation.
Boussingault* fed a duck with fifty grammes of gum-arabic,
and found forty-six in the excrement; and Frerichs, Blond-
lot, and Lehmannf found that neither the saliva nor the
gastric juice exercised any effect upon this substance.

I confined myself for four days to a diet consisting ex-
clusively of gum-arabic and water. During this period I
ingested a total of 29,750 grains of gum, of which 27,651
were recovered with the excrement, and it is very probable
the whole amount was thus discharged. I lost during the
experiments 3 '33 pounds, and suffered very much from
hunger and intestinal irritation. Hence I considered my-
self warranted in concluding "that gum is altogether inca-
pable of assimilation, and therefore possesses no calorifacient
or nutritive power whatever, but is, on the contrary, a source
of irritation to the digestive organs."J

The administration of gum-water to invalids is, there-
fore, I think, to be condemned not only as useless but as
injurious. The water is soon absorbed, leaving the undi-
gested gum in the alimentary canal to excite disturbance.
I have seen several cases of intestinal irritation in children
from the eating of gum-drops.

The stories which have been told of individuals living
for weeks together on gum alone are not entitled to credit.

* Memoires de Chimie Agricole et de Physiologie, p. 232.
f Lehmann's Physiological Chemistry, vol. ii. p. 386.
% Physiological Memoirs, p. 131 et seq.

488 A TREATISE ON HYGIENE.

Inorganic Aliments. — Under this head are included
those mineral substances which are found as constituents
of the compound articles of food, or which are ingested un-
combined. They are equally necessary with the organic
aliments to the maintenance of life, and contribute directly
to the formation of tissues. The bones, the muscles, the
viscera, the skin and appendages, and the blood all contain
mineral matter; and unless the necessary substances to
replenish the waste which is constantly going on are sup-
plied, disease and even death are the results.

Mineral substances will not of themselves support life,
although there is evidence to show that some nations or
tribes subsist, during certain seasons, wholly or in part on
matters which appear to be inorganic. Thus Humboldt*
states that the Ottomaks, a tribe of Indians living on the
Oronoco, in South America, during the rainy season live
entirely on a ferruginous clay, of which each adult eats a
pound or more daily. Other nations of South America eat
earth, which, according to Ehrenberg, consists of a mixture
of talc and mica. In Georgia and Florida there are dirt-
eaters, as they are called, who ingest daily, not from neces-
sity but from a bad habit, large quantities of a kind of clay
found in those States. And on the Pacific coast several
tribes of Indians reside who eat clay as a part of their food.
In Sweden, in 1832, on account of the famine, the little
flour which the inhabitants possessed was mixed with the
bark of trees and a silicious earth and baked into bread.f
Retzius found this earth to consist of the remains of nine-
teen different species of fossil infusoria.

The effect of the earth-eating propensity on those inhab-
itants of Georgia and Florida who indulge in it is very well
marked. They are pale and exsanguined, the muscles

* Reise in den Aquinoctial Legenden, B. iv. p. 551.
f Poggendorf's Annalen, B. xxix. p. 261.

ALIMENTARY PRINCIPLES. 489

feebly developed, the skin dry and harsh, the abdomen
enormously distended, and the mental faculties on a par
with the physical powers. In all these cases in which life
has been sustained on clay and similar substances, there
can be no doubt in regard to the presence of organic
matters.

Without going into the consideration of all the inorganic
substances which enter the composition of the animal tis-
sues, and which must be supplied from without, in order
that the system may be kept in a normal condition, it will
be interesting to notice some of the more important of them
in their relations to human health.

Salt. — Salt is not only found in most articles of food as
they naturally exist, but instinct prompts its addition to
nearly all the substances which are used as aliments by
man. Its function in the organism is something more than
that of aiding in the formation of tissue, as it is directly
useful in facilitating digestion, by its being the source
whence the hydrochloric acid of the gastric juice is de-
rived.

The results which follow confinement to a diet entirely
free from salt, or at least containing only the proportion
which is chemically united to the other constituents of the
food, are very striking. Boussingault,* several years since,
investigated this subject thoroughly, and his conclusions
are not only interesting but extremely important, as show-
ing how necessary a full allowance of salt is to animals.

Six young bulls were taken for the subjects of the ex-
periments. To three of them salt was given with the
forage, and from the other three it was entirely withheld
for thirteen months. While it was found that no appre-
ciable effect was produced on the development of the ani-
mals, it was very definitely ascertained that, so far as their

* Memoires de Chiraie Agricole et de Physiologie, p. 251 et seq.

490 A TREATISE ON HYGIENE.

appearance was concerned, those which had been supplied
with salt were in a much better condition than the others.
During the first fourteen days no difference was observable,
but after the lapse of a month the effects were very dis-
tinctly seen. The skin of both lots was soft and sound,
but in those which had received salt the hair was smooth
and shining; while in the others it was dull and erect.
After a year had passed, in the animals which had not
been supplied with salt the hair was matted, and in places
it had fallen out, giving to the skin an unhealthy appear-
ance; on the contrary, the others were lively, the skin
smooth and shining, and the whole aspect indicative of
good condition.

No one who has seen much of animals can have failed
to notice the avidity with which they lick up salt which
may be offered to them; and every practical farmer under-
stands the necessity which exists of supplying them with
it at regular intervals.

It is impossible at the present day to observe in man the
effects of a deficiency of salt in the food, unless some one
should voluntarily subject himself to the experiment of de-
nying himself the use of it. We are told, however, that,
several centuries since, certain crimes were punished in
Holland by confining the offenders to a diet of bread and
water, with an entire deprivation of salt. The criminals
were said to have become insane, and finally idiotic, in
which condition they died. Whether these stories are true
or not, there is enough evidence, regarding the subject from
a purely physiological point of view, to show that salt is an
essential element of our food, and that man could not exist
long in health without it.

Another question connected with the use of salt as an
adjunct to the food relates to the results which ensue when
it is ingested in large quantity for a long time. As is well
known, salt possesses the faculty of preserving animal sub-

ALIMENTARY PRINCIPLES. 491

stances from putrefaction, and advantage is taken of this
property to preserve pork, beef, and other meats in such a
form as to admit of their being used as food a long time
after they would otherwise have undergone decomposition.
The exact nature of the influence which salt exerts over
the substances thus preserved is not altogether understood.
According to Liebig, it is due to the affinity which salt has
for water, whereby it absorbs a great part of the fluid pres-
ent, and thus removes one of the essential conditions of
putrefaction — moisture. This explanation is doubtless cor-
rect as far as it goes. We know that fish, ham, and other
salt meats will readily undergo putrefaction if they are ex-
posed so that they can freely absorb moisture. But salt
also produces another effect which tends to prevent decom-
position ; it takes away a portion of the albumen of the
meat, which is present in a soluble form, a fact to which
Liebig has also called attention.

Now, in abstracting from the animal substances submit-
ted to its action a great portion of the fluid they contain,
salt, as Moleschott* reminds us, and as is above intimated,
removes from flesh a part of its most nutritious elements.
Individuals, therefore, subjected to a diet consisting mainly
of salt meat, are not properly nourished, and hence the
constitutional disturbance which, under such a circum-
stance, is always manifested, is due, not to the direct
action of the salt, but to the absence from the food of
matters which are essential to the well-being of the organ-
ism. It is sufficient in this place to state that scurvy and
other forms of cachexia, which follow the prolonged use of
salt meat, are not the direct consequences of the large
quantity of salt ingested— the full consideration of the
effects of such food falling under another division of the
subject.

* Lehre der Narungsmittel. Dritte Auflage. Erlangen, 1858, p. 154.

492 A TREATISE ON HYGIENE.

Phosphate of lime and carbonate of lime are among the
most important mineral constituents of the food, if not pre-
eminently essential, forming as they do two-thirds of the
weight of the osseous tissue, and being found in consider-
able quantity in other parts of the body. Bones in which
the proportion of these salts is reduced much below the
normal standard are soft and easily bent. The disease
called rachitis or rickets consists in a deficient amount of
phosphate and carbonate of lime in the bones, rendering
them unable to support the weight of the body.

Of the two. salts, phosphate of lime occurs in the bones
in much larger proportion than the carbonate, about 57
parts of the first to 8 of the second being present. In the
food they occur as normal constituents of most of the ali-
mentary substances. Wheat, rye, corn, barley, oats, and
other grains, carrots, potatoes, turnips, etc. contain the phos-
phate in considerable quantity. It is also found in abund-
ance in animal food. The carbonate of lime is not so gen-
erally present in the articles used as food, but most of them
contain it in quite an appreciable amount.

During certain states of the system phosphate of lime is
required in such a large quantity that enough is not con-
tained in the food to meet the wants of the organism, and
hence the bones become soft and pliable, and if fractured
do not readily unite. This is the case in pregnancy and
during dentition in children. In such conditions phosphate
of lime should be mixed with the food, and the best results
will generally follow. It is well known that when hens
are fed upon food which is deficient in lime their eggs are
devoid of shells, and that by feeding them upon substances
which contain it in due proportion, or giving them lime-
water as a drink, the shells are again formed around the
eggs.

Beneke* has called attention to the value of phosphate

* Der phosphorsaure Kalk in physiologischer und therapeutischer.
Beziehung, 1851. And, Zur Physiologie und Pathologie des phosphor-
sauren und oxalsauren Kalkes.

ALIMENTARY PRINCIPLES. 493

of lime in cell-formation, and its consequent probable benefit
in those conditions of the system in which there is defective
nutrition, such as scrofula, phthisis, etc. I have treated
several cases of scrofulous enlargements of the glands, both
of the mesentery and neck, with this substance, and always
with very positive advantage.

Guano and the various artificial manures contain phos-
phate of lime in large quantity, and on this fact mainly
depends their value as fertilizers. What is thus given to
vegetables is returned to man through the food which he
ingests.

Iron. — Though present but in small quantity, iron is
found in many of the animal tissues, especially in the blood,
where it plays a very important though not thoroughly un-
derstood part. In chlorosis and other forms of anemia iron
is found in diminished quantity in this fluid, and whether
or not the symptoms which attend these affections are due
to its deficiency, they are mitigated or altogether removed
through its action when administered as a medicine.

Iron exists in most of the articles used as food, both of
the animal and vegetable kingdoms.

I have several times verified a statement made I think
by Prof. Simpson, of Edinburgh, that manganese is equally
effectual with iron in causing an increase of the red corpus-
cles of the blood in anemia, and by administering it to dogs
have always found the amount of iron to be augmented
under its influence.

There are several other mineral substances which are
necessary articles of food. Among these are sulphur and
phosphorus, which, as has already been mentioned, are con-
stituents of the nitrogenous alimentary substances. The
former and its combinations exist in almost all the tissues,
and are excreted in the urine in increased amount after ex-
cessive muscular action. The latter is found in the brain
and in the bones as an essential element of the phosphate

404 A TREATISE ON HYGIENE.

of lime, which constitutes so important a part of their
composition.

One of the most essential of the inorganic aliments—
water— has already engaged our attention, when its hygi-
enic relations as food, with its other connections, were
pointed out. It is not necessary, therefore, to refer to it

again.

Before proceeding to the consideration of the compound
aliments, it will be proper to call attention to the regula-
tions by which we should be governed in regard to the
quantity and quality of our food, the periods for eating,
and other hygienic circumstances bearing upon the sub-
ject.

CHAPTER XXIII.

PHYSIOLOGICAL AND SANITARY RELATIONS OF FOOD.

Quantity. — The quantity of food which should be in-
gested must vary, of course, according to the conditions in
which the individual is placed, and is also dependent, to a
considerable extent, on the quality of the aliment placed
at his disposal. During infancy and childhood more food
is proportionably eaten than in adult age, and more is re-
quired, in consequence of the development of tissue which
is taking place. Compared to the weight of its body an
infant at the breast takes daily a larger amount of food
than a grown man, and youths about the age of puberty
not only relatively, but absolutely more in many instances.
It is very rarely the case that children will eat a greater
quantity of the ordinary aliments than is requisite for
them, and therefore it is indiscreet in parents to put too

PHYSIOLOGICAL AND SANITARY RELATIONS OF FOOD. 495

great restrictions on them in this respect. It is to be re-
collected that digestion at such ages is performed rapidly,
that the constant activity of mind and body which children
manifest produces a great destruction of tissue, and that
the growth and development of the body, which are un-
ceasingly going on, require material to be supplied in
abundance. Food in them is not only necessary to make
up for the losses consequent on the organic processes, but
to provide pabulum for the new deposits of tissue which
are to be formed. The first condition therefore which
modifies the quantity of food is age.

In the adult period a large amount of food is also re-
quired. The growth of the body is completed, but the
mental and physical faculties are now exercised to their
fullest extent, and consequently the absolute destruction
of tissue is greater at this age than at any other, and an
absolutely greater amount of food is generally necessary.
The size of the body being increased, also necessitates a
larger amount of food for its nourishment.

In old age the quantity of food ingested is at its mini-
mum; not only are the digestive powers weaker, but the
wants of the system are less, consequent upon the dimin-
ished activity both of mind and body attendant upon
advanced years.

Climate. — The amount of food ingested by the inhab-
itants of warm climates is less than that taken by the
residents of cold ones. The East Indian lives on a little
rice, while the Greenlander eats several pounds of fat meat
daily. Even in temperate climates the seasons exercise
an influence not only over the quality but the quantity of
food taken into the system. Most persons eat more in
winter than in summer. The cause is doubtless to be
found in the fact that in cold weather a greater quantity
of respiratory food is required, in order to keep up the ani-
mal heat, than in hot weather, when the external tempera-

496 A TREATISE ON HYGIENE.

ture more nearly approaches the temperature of the body.
When the subject of climate was under consideration, in-
stances were adduced relative to the quantity of food taken
by the inhabitants of cold regions. Fatty substances form
the principal part of their diet, and if these were not used
in immense quantities they would undoubtedly perish with
cold. In the torrid zone, however, where the opposite
condition as to temperature prevails, fruits and farinacea
are almost entirely used, to the exclusion of animal food;
and as physical exertion is avoided as far as possible, little
purely histogenetic food is required.

Occupation also influences the subject. Individuals
whose business requires much bodily exertion, or that
they should spend much of their time in the open air, eat
more than those of sedentary habits. Intense mental oc-
cupation is not consistent with indulgence in the pleasures
of the table. Hard students are rarely great eaters. On
the contrary, the soldier, the sailor, or the plowman re-
quires a large amount of food, of which a considerable
portion must be pre-eminently tissue forming. Muscular
exertion, therefore, more than mental exertion, causes
destruction of tissue, and consequently a greater demand
for food for the supply of the waste.

Sex. — As a rule, men eat more than women, and this
mainly on account of the greater degree of activity of their
lives. During pregnancy and lactation the appetite of the
female is increased, owing to the additional demands made
upon her system consequent on the growth of the foetus,
and the supply of nourishment for the infant after birth.

There are therefore several factors to be taken into con-
sideration in determining the quantity of food to be in-
gested. Many estimates have been made, differing, as is
usual in such cases, very much from each other. From
my own experience, and from a thorough inspection of the
dietaries in use in the hospitals and armies of Europe, I

PHYSIOLOGICAL AND SANITARY RELATIONS OF FOOD. 497

am clearly of the opinion that no people eat more than the
inhabitants of the United States. Taking a healthy adult
American as our standard, the quantity of food required to
maintain his organism not only in a normal condition, but
up to the full measure of physical and mental capability,
may be placed at about 40 ounces, of which two-thirds
should be vegetable and one-third animal. This is in ad-
dition to the water he may drink, which will amount to
about 20 fluid ounces, and to 8 or 10 fluid ounces of tea or
coffee. When we come to the subject of dietaries and
rations we shall resume the consideration of this subject
more at length.

If an excessive amount of food be habitually taken, the
digestive organs have more work thrown upon them than
they can accomplish, and consequently derangement of
their functions occurs. Before, however, an advanced
stage of dyspepsia ■ is reached, obesity or plethora is de-
veloped, and a tendency to disease of the brain, the heart,
the liver, or other organs, is established. The regulation
of the appetite receives very little attention until warnings
in the shape of functional disturbance are given, and then
it is often too late.

Mr. Lawrence* relates a very instructive case which
bears upon this point.

"A very long time ago I was intimately acquainted with
a young physician of spare habit, active mind and body,
zealously pursuing his profession and taking much walking
exercise. Meeting with deserved success, he found it neces-
sary to leave off walking and to keep a carriage. Having
agreeable manners and social habits, he lived much in
society, when the mode of living was freer than at present,
though he did not commit excess. He soon began to in-

* Lectures on Surgery. Delivered in St. Bartholomew's Hospital.
London, 1863, p. 114.

498 A TREATISE ON HYGIENE.

crease in bulk, and was joked by his friends on the subject.
It was his custom to celebrate his birthday by a jovial
meeting, which was concluded by a bowl of punch after
supper. On the last occasion he had been in excellent
health, and was perfectly well next morning when he left
home in his carriage. Having occasion to draw up the
blind, he found the left arm motionless and the leg very
stiff; it was an attack of hemiplegia, which obliged him to
give up his profession. After surviving for a few years, he
sunk under advancing disease of the brain."

But the influence of excessive indulgence in the pleasures
of the table does not stop with the digestive system and
the establishment of proclivities to disease. Habits of
idleness and indolence are set up, which add to the diffi-
culties. The metamorphosis of the tissues does not pro-
gress with the normal rate of activity, and hence they be-
come soft and unhealthy, with greatly increased liability
to disorganization. Moreover, the products of the decay
of the tissues instead of being rapidly excreted are retained
in the system, and add to the unhealthy condition. An
organism thus circumstanced, although not necessarily dis-
eased, is like a powder mine, which only requires a little
spark to cause the explosion. A trifling accident or affec-
tion may act as the spark, and produce results which never
would have followed had the system been in a normal
state.

Deficiency of food is even more productive of disorder.
In starvation the tissues of the body are consumed for the
production of heat, and, their place not being supplied,
rapid loss of weight is the consequence. The various
other vital processes all involve decomposition of the sub-
stance of organs, and add to the loss which the body
undergoes. Chossat* ascertained that the depreciation of

* Recherches Experimentales sur 1'Inanition, etc. Paris, 1843, p. 4?
et seq.

PHYSIOLOGICAL AND SANITARY RELATIONS OF FOOD. 499

weight in starvation is greatest during the two or three
days which immediately precede death.

Human beings subjected to starvation generally become
delirious, from the great debility induced by the want of
food. They rarely survive the complete deprivation of
food longer than eight or ten days, though instances are
on record of life continuing during an abstinence of several
weeks. Such cases are always open to the suspicion of

deceit.

From insufficient food, if the condition continues for a
few weeks, disease is almost invariably induced. Typhus
and typhoid fever, scurvy, and anemia are the legitimate
consequences. In early childhood the whole development
of the individual may be arrested, or particular organs
may fail to attain to a full growth. Even the foetus in
utero is affected by the food ingested by the mother, and
if there is a deficiency in quality or quantity, the result to
the offspring is often such as to interfere with the proper
nutrition of its organs, and hence it may be born stunted
in growth or with deformed limbs. Pregnant women
should always be allowed a full and nutritious diet.

In regard, further, to the quantity of food to be ingested
by healthy persons, the appetite may generally be depended
on for an indication, if means are not taken, by the use of
condiments and luxurious modes of cooking, to stimulate
this sensation to an unnatural point. It very rarely occurs
that a person eats too much bread or meat, or of a plain
dinner of roast beef and vegetables. The danger is from
highly-seasoned aliments, and from those which are made
more alluring through the skill of the cook. In these
cases the judgment should always be exercised and the
appetite held in restraint.

Quality of the Food. — As we have seen, there are dif-
ferent kinds of food, each of which fulfils its office in the
economy. It is therefore necessary that the food of man

500 A TREATISE ON HYGIENE.

should consist of a variety of substances, in order that the
several functions of the organism may be properly carried
on. No fact in dietetics is better established than this
relative to the absolute necessity of a mixture of aliments.
The experiments of Magendie, some years since, afforded
conclusive evidence on this point, if it had not already
been sufficiently ascertained by the results which were
found to follow in man when he was confined to a uniform
diet.

Magendie caused different dogs to be fed separately with
sugar, gum, olive oil, and butter, with the invariable result
that death took place in a little more than a month. I
have subjected animals to a uniform diet of nitrogenous
substances — albumen, gelatin, and casein — and always
found that death took place within three months. Even
when the food consisted of two primary aliments, such as
bread, which contains gluten, and starch, the health was
always deranged, though death did not occur.

All dietaries should be constructed so as to allow of a
due admixture of animal and vegetable food, containing
substances belonging to all the classes previously men-
tioned. Even this is not enough; the articles must be
varied at times, or disease will be very apt to occur. Thus
it will not answer to adhere uniformly to a diet consisting
of bread, beef, and potatoes, although such substances are
excellent articles of food, and are sufficient to meet every
want of the economy. It will be necessary occasionally to
substitute some other meat for beef, and some other vege-
table for potatoes, and to introduce an extra article at
times. If care is not taken to insure variability in the
diet of individuals, their sanitary condition always becomes
lowered. This is seen in armies, navies, and hospitals,
when either through necessity or neglect the food is not
sufficiently varied in its character. The strength of the
men is not at its maximum : they become low-spirited and

PHYSIOLOGICAL AND SANITARY RELATIONS OF FOOD. 501

nostalgic; scurvy and fever appear; wounds heal with
difficulty, and convalescence is slow.

Although many vegetable substances contain nitrogenous
matter, the structure of the teeth and alimentary canal of
man shows that nature intended that animal food should
contribute to his sustenance. It is doubtless the case
that man can live on vegetables alone, and perhaps in
some instances nourish on them, particularly in hot cli-
mates, where he does not indulge either in strong physical
or mental exertion. But in temperate or cold climates,
especially if it is necessary to exert his mental or muscular
systems to any considerable extent, he soon experiences
the want of more invigorating food than can be obtained
from the vegetable kingdom alone. On the other hand,
in temperate or warm climates a diet exclusively animal is
calculated to induce a plethoric condition of the system,
unless its effects are counterbalanced by a proportionate
amount of bodily exercise being indulged in. It may be
safely asserted that the more nutritious the diet— provided
it is not made too stimulant by condiments— to which a
man is subjected, the more work he is capable of perform-
ing, whether this be mental or physical. It is of course to
be & 'understood that the quantity taken should be such as
will not overtax his digestive organs.

Periods for Eating.— Habit is the principal influence
exerted to determine the times for taking nourishment.
The importance of regularity in this respect is generally
admitted by all. When the meals are taken at stated
periods, digestion is always better performed and the sys-
tem better nourished than when they are eaten at irregular
times. The digestive organs are prepared for the reception
of the food at the periods they have been accustomed to
receive it, and hence they act with greater efficiency than
if aliment is ingested without regard to system.

Three meals should be eaten daily— one in the morning,

502 A TREATISE ON HYGIENE.

soon after getting up, another some time after the middle
of the day, and a third toward evening. There is no regu-
larity observed by civilized nations relative to the hours for
these meals. They are arranged according to the necessi-
ties or caprices of the individuals concerned. There are
three points, however, to be observed in considering the
matter hygienically, and if they are attended to it does
not make much difference in regard to the exact hours for
breakfasting, dining, and supping.

First, breakfast should be taken immediately after rising
in the morning, and before any work is performed. This
meal being that after the longest fast, is more important
than any other. If any considerable length of time is
allowed to elapse before it is eaten, the system is certain to
suffer, and especially so if much muscular exertion is made.
Soldiers should always be fed before they are sent to drills,
parades, or other labor. Not only will the work be done
more efficiently, but the health will be better preserved.
It has already been shown how important it is to have
taken food into the stomach, before being subjected to the
influence of the malarious emanations which have been
given off during the night.

In the second place, strong bodily exertion should, as
far as possible, be avoided after dinner, especially if this is
made the principal meal. Digestion is not accomplished
as perfectly under such circumstances as if moderate exer-
cise or even rest for an hour is indulged in. With many
persons it is impossible to adhere to this rule, but it is not
less important for that reason.

And thirdly, the evening meal should not be taken im-
mediately before going to bed. Although rest is favorable
to the first stage of digestion, or that which is performed in
the stomach, it is not so with the subsequent stages, when
the food has reached the intestines. At least two hours
should be allowed to intervene between the last meal and

PHYSIOLOGICAL AND SANITARY RELATIONS OF FOOD. 503

the hour of retiring. Under all circumstances, the evening
meal should be the lightest of the three.

Mental Emotion. — The influence of the mind over diges-
tion is very striking, and often of such a character as to
interfere materially with the due performance of this func-
tion. It is very important with invalids and children,
whose nervous systems are easily affected, that nothing
should be allowed to excite, distress, or irritate them while
digestion is going on. I have several times seen children
rendered ill by indiscreet persons annoying or fretting them
at meals. Intense anxiety of mind will in most persons
derange this process.

In the following chapters relative to food, the compound
aliments, as they are presented ready formed for the use of
mankind, will engage our attention. These will be consid-
ered under three heads.

1st. Those which are derived from the animal kingdom.

2d. Those which are derived from the vegetable king-
dom.

3d. The accessory articles of food, which are derived
from both kingdoms, but which will be more properly
treated of under a distinct head.

The mineral substances used as food are, as we have
seen, incorporated with those derived from the animal or
vegetable kingdoms of nature.

504 A TREATISE ON HYGIENE.

CHAPTER XXIV.

ANIMAL COMPOUND ALIMENTS.

Animal food, as we ordinarily meet with it, consists
of nitrogenous matter in union with certain mineral sub-
stances and fat. We have therefore in it all the essential
elements for the formation of tissue and the maintenance
of the animal heat ; and on it, it is perfectly possible for
man in any climate to exist and continue in a normal con-
dition. In cold climates the principal part of his suste-
nance is derived from this source, and, indeed, in polar
regions vegetable food is never ingested by the inhab-
itants.

The first food which is taken by man and other mam-
mals is derived from the animal kingdom, and therefore it
will be proper to consider it first.

Milk. — Milk has been regarded as the type of what
food ought to be, from the fact that on it alone the young
of all mammals are reared. We find in it nitrogenous mat-
ters, fat, sugar, mineral substances, members of the four
groups into which aliments can be arranged; but it cannot
be considered as the representative of all food, for the reason
that, however well adapted it may be for the nourishment
of the body during infancy, it is not suited to supply the
place of all other food for adults; and this, not only on
account of any peculiarity of composition or arrangement
of the substances of which it is formed, but from the fact
that the adult stomach is not well adapted to digest it.

Still we find whole nations who make it the chief article
of their diet. The Tartars, the Laplanders, and other wan-

ANIMAL COMPOUND ALIMENTS. 505

dering tribes subsist to a great degree on milk alone. Doubt-
less habit influences the matter, as it does most all other of
our manners and actions.

We can, without much manipulation, obtain from milk
the principal elementary substances of which it is com-
posed. On allowing it to stand for a few hours the cream,
which consists mainly of the fatty portion, rises to the top,
and can be readily removed. A drop submitted to micro-
scopical examination is seen to consist of innumerable
globular bodies possessed of a high refracting power, and
answering to all 'the indications of oil globules. They are
suspended in a colorless watery fluid, to which they give
the characteristic opacity and white color. These globules,
by their fusion, which takes place on strong mechanical
agitation, form butter; and the fluid which remains, butter-
milk, does not differ essentially in composition from skimmed
milk.

By allowing milk to stand for a day or two, or in warm
weather for a few hours, it separates into two portions —
one a semi-solid, the curd, the other a thin, watery liquid,
the whey. The curd consists almost entirely of casein, the
nitrogenous substance of milk, and that from which cheese
is made. The whey is water containing the sugar and the
principal part of the mineral constituents.

The proportion of these substances entering into the
composition of milk varies according to the animal from
which it is derived. Cow's milk, which may be taken as
a standard, I found to possess the following constituents.
The cow from which it was taken was grazed in a fine
clover meadow, and fed on corn meal every morning.

Water ^ 26

Solids 222U

n • 78-59

Casein

Butter m0

Sugar 49 ' 68

Sail 10 ' 2

50G A TREATISE ON HYGIENE.

Human milk contains less butter, sugar, and casein than
cow's milk. The milk of a healthy nurse, thirty years of
age, who had been delivered six months previously, I found
to be constituted as follows : —

Water 88720

Solids 112-80

Casein 38 27

Butter 28 67

Sugar 4430

Salts 156

The density of cow's milk ranges between 1030 and
1033. Vernois and Becquerel,* as the mean of thirty de-
terminations, place it at 1033*38. As the mean of eighty
observations of pure milk, in which there was no oppor-
tunity for adulteration, I found it to be 1032 - 78.

Probably no article of food is so frequently adulterated
as milk. Fortunately the substance most generally added
to it — water — is not of itself injurious, but most persons
who desire to have this liquid mixed with the milk they
buy prefer to add it themselves. Other substances, how-
ever, are incorporated with milk, either to increase its spe-
cific gravity after it has been reduced by water, or to re-
store to it qualities which too much water has taken from
it. Molasses, salt, starch, chalk, and it is said calves' or
sheeps' brains, are thus added to milk.

The detection of the substances used in the adulteration
of milk is comparatively an easy matter. As we have said,
the specific gravity of this fluid ranges between 1028 and
1033. If water be added, the specific gravity is lowered,
and we at once have an indication of the extent of the
adulteration.

For determining the specific gravity of milk, the specific
gravity bottle and balance may be used, or what is more

* Du Lait chez la Femme, etc. Paris, 1853, p. 130. Also Ann. d'Hy-
giene, 1853, tome 1.

ANIMAL COMPOUND ALIMENTS. 507

convenient, though not so accurate, the ordinary hydrom-
eter, which is graduated for the purpose of being applied to
milk. As the results of many experiments, I have found
that the following table expresses the specific gravities
which will be obtained by the addition of the stated quan-
tities of water to the milk : —

Pure milk 1032

Ten parts of water 1029

Fifteen parts of water 1027

Twenty parts of water 1026

Forty parts of water 1016

The hydrometer, however, is not altogether to be relied
on, for the reason that a large proportion of cream might
give rise, from its low specific gravity, to an error, by lead-
ing to the conclusion that the result obtained was due to
the admixture of water. It is therefore advisable to use
the lactometer, by which the amount of cream present may
be accurately ascertained. This instrument is a graduated
test-tube. The milk is placed in it, and the instrument set
aside long enough for the whole of the cream to rise to the
top. The number of divisions which it covers is then read
off. The average percentage of cream as thus obtained is
about ten, though it is not uncommon in pure milk to have
it as low as seven, and in very rich milk as high as fifteen
and even twenty.

If any substances have been added to increase the spe-
cific gravity, or to give a thickness to the milk after water
has been mixed with it, the microscope readily reveals the
presence of such as are insoluble. I have several times
detected starch in milk, but never any other adulteration
except water, though it would appear that in Europe the
substances previously mentioned are sometimes used.

Milk forms a very useful article of diet for the sick,
especially when cooked with arrow-root and other forms of
starch. In combination with eggs, flour, etc. it makes cus-

508 A TREATISE ON HYGIENE.

tards and puddings, which are always nutritious, and gen-
erally digestible, but are too rich for very sick persons.
Nothing more useful than milk-punch — made with either
brandy or whisky — can be employed in the treatment of
the low types of fever so frequently met with in armies.
Added to tea or coffee, milk increases the nutritive prop-
erties of these beverages and lessens their action on the
nervous system.

Butter is generally added to farinaceous food, to which
it gives flavor, and renders it more useful to the system by
supplying the fatty principle. The digestibility of such
aliments is increased by the addition of butter.

Casein has already engaged our attention. As cheese
it is an exceedingly nutritious substance, and, if new, is
readily digested. Old cheese, however, from the chemical
change which it has generally undergone, is apt to prove
irritating to the alimentary canal, and is sometimes pro-
ductive of very serious results. Cheese is not suited for
the sick.

Whey, which contains the sugar and the greater part of
the salts, also retains a portion of the casein and butter.
It is a nutritious and easily digested liquid. In some parts
of Germany it is extensively used in the treatment of dis-
eases, but possesses no other properties than those of an
alimentary character.

Condensed milk, which is in extensive use in our armies
and hospitals, answers, when well prepared, for all the
dietetical purposes to which fresh milk can be applied.
On some accounts it is even preferable, as it enables us to
obtain, in a concentrated form, the principles which exist
in milk, and is readily diluted to any degree. It has
proved most serviceable on the battle-field as a source of
nutriment for the wounded, and is so readily transported
as to be always at hand.

Eggs. — Eggs contain nitrogenous, oily, and mineral sub-

ANIMAL COMPOUND ALIMENTS. 509

stances, and hence are both tissue forming and heat pro-
ducing. The white of the egg consists of water, albumen,
and a considerable proportion of saline matter; the yolk
consists of water, albumen, oil which is emulsified by
mixture with the albumen, and salts.

Eggs contain a great deal of nutriment in a small bulk,
and therefore are useful articles of diet for those invalids
in whom it is not advisable to load the stomach with much
food. Generally they are of easy degestibility, though
much depends in this respect on the way in which they
are cooked. Kaw eggs are not so readily digested as those
in which the albumen has been coagulated by heat, though
Beaumont arrived at an opposite conclusion. Eggs which
are boiled so as to just coagulate the white without harden-
ing the yolk are most wholesome. I have, however, met
with several persons whose stomachs would not tolerate a
soft-boiled egg, but who could readily digest several that
had been thoroughly hardened throughout by long boiling.
Fried, roasted, or scrambled eggs are comparatively difficult
of digestion.

The raw yolk of the egg, beaten up with milk, sugar, and
brandy or whisky, forms a highly nourishing and stimulant
diet in cases of low fever and retarded convalescence.

Meat. — The substances used by man as food, and which
come under this head, consist of the muscular fiber, vis-
cera, and other parts of animals. The several classes,
mammals, birds, reptiles, fish, articulates, and mollusks,
all contribute to supply him with aliment.

This kind of animal food contains albumen, syntonin or
musculin— identical in composition with gluten — fat, and
mineral substances. By boiling there is extracted from
flesh, but especially from bones, cartilages, and ligaments,
a substance to which the name of gelatin has been given,
and which was for a long time supposed to be highly
nutritious. It is now, however, ascertained that it is not

510 A TREATISE ON HYGIENE.

capable of contributing to any of the requirements of the
organism, but is excreted mainly by the kidneys very soon
after its absorption into the blood.

Without entering into the consideration of the peculiar
properties of all the parts of animals which are used as
food, we shall confine our remarks to general observations
on the flesh, which is that portion to which the greatest
importance is to be attached.

Mammals. — The animals of this class which are used as
food are very numerous, and differ very much from each
other in the character of their flesh and in the degree of
digestibility which it possesses. Beef and mutton are
easily digested, while pork is not so readily acted upon by
the digestive juices. Yeal is more difficult of digestion
than beef, but lamb and young pig easier than mutton or
pork. It would appear to be uniformly the case that, with
the exception of veal, the flesh of young animals is more
readily digested than that of the full-grown animal.

As a general rule, the flesh of wild animals is more ten-
der than that of those which are domesticated. This is
accounted for by the fact that, owing to the greater amount
of muscular exercise which they take, the flesh is more
rapidly renewed, and is consequently younger than that of
animals which are kept in a condition of comparative rest.
Thus the flesh of the buffalo is always more tender, other
things being equal, than the flesh of the ox, which it
resembles very closely in every respect.

The flesh of female animals is not so tough as that of
the male. Castration always increases the tenderness and
adds to the flavor.

In order that flesh should be readily acted upon by the
gastric and intestinal juices it must be divided into small
portions. The chemist, when he wishes to dissolve any
substance, pulverizes it, in order that a greater surface may
be submitted to the action of the dissolving agent. If this

ANIMAL COMPOUND ALIMENTS. 511

is not done, the solution always requires a longer time to
be effected than when the substance is finely comminuted.
The teeth are intended to produce the same effect upon
the food as the mortar and pestle of the chemist upon the
matters to be triturated, and mastication, if properly per-
formed, very greatly facilitates the digestive process. It is
too often the case that individuals do not give sufficient
time to this operation, and the food being swallowed in
large lumps requires a correspondingly longer time to be
converted into chyme. That this neglect is a fruitful cause
of dyspepsia, there can be no doubt. The trouble does not.
however, stop here, for a great part of such imperfectly
masticated food, not being subjected to the action of the
juices in the alimentary canal, is excreted unaltered, and
consequently its nutritive properties are in a great measure
lost to the system.

The animal food allowed to the soldiers of the United
States Army is beef or pork. The former is issued fresh
or salted; the latter salted as mess-pork, or salted and
smoked as bacon. The quantity of beef, salt or fresh,
issued per day is one and a quarter pounds; the quantity
of pork or bacon is three-quarters of a pound. "Why a dif-
ference of half a pound should be made between the quan-
tity of beef and pork, I do not know. Certainly the latter
is not more nutritive than the former.

The Army Regulations require that fresh beef shall be
issued in lieu of salt meat as often as the commanding
officer may require it. Ordinarily the men get fresh meat
four days in the week, and salt meat the other three.

As has already been said, salt meat is not so nutritious
as fresh. According to Liebig,* the brine used in pre-
serving meat "contains the chief constituents of a concen-
trated soup or infusion of meat, and that therefore, in the

* Researches on the Chemistry of Food. London, 1847, p. 13L

512 A TREATISE ON HYGIENE.

process of salting, the composition of the flesh is changed,
and this too in a much greater degree than occurs in boil-
ing. In boiling, the highly nutritious albumen remains in
the coagulated state in the mass of flesh, but in salting, the
albumen is separated from the flesh; for when the brine of
salted meat is heated to boiling, a large quantity of albumen
separates as a coagulum. This brine has an acid reaction,
and gives, with ammonia, a copious precipitate of the
double phosphate of ammonia and magnesia." Lactic acid,
kreatin, and kreatinin are also present.

When the subject of salt was under consideration, the
effect of this substance on meat was also alluded to. The
fact cannot be too strongly insisted upon that salt meat is
far less nutritious than fresh. A portion of the most valu-
able constituents of flesh are abstracted by the brine, and a
larger quantity of salt meat should be allowed to make up
for the deficiency created. Even if there is no restriction
as to quantity, it is very certain that the health of man
cannot be long sustained upon a diet of which salt meat
forms a considerable proportion.

The manner of cooking also affects the digestibility of
flesh. Roasting develops the flavor, and likewise renders
flesh capable of being easier digested than any other
method of cooking. It should be carried just so far as to
brown the outside without coagulating the albumen of the
juice or hardening the muscular fiber. Broiling is also an
excellent way of cooking meat; it is analogous to roasting
in its effect on flesh, and like it should not be continued
too long. Boiling is generally not so advantageous. Salt
meats are, however, better cooked in this way than any
other. Care is required in cooking by this method to see
that the water is boiling hot when the meat is put into it,
in order that the albumen of the outside portion may be
thoroughly coagulated, and the escape of the juices thus
prevented. If this point is neglected and the meat is put

ANIMAL COMPOUND ALIMENTS. 513

into cold water, which is then gradually raised to the tem-
perature of the boiling point, the juices escape into the
water, in a great measure, before the coagulation of the
albumen is effected, and thus the meat is rendered dry and
difficult of digestion, and is deprived of a considerable por-
tion of its most nutritious constituents.

Frying is a culinary process which should be altogether
discarded as the very worst method of cooking which has
ever been devised. The medium, fat or oil, requires a
very high temperature to bring it to the boiling point, and
hence the meat is rendered exceedingly dry and tough.
Moreover, the excessive heat renders the oil or fat empy-
reumatic, and thus irritating to the digestive organs with
which it comes in contact.

In baking, the juices are kept in the meat, but the pro-
cess is too analogous to frying to be a good one. Stewing
is, on the contrary, a very excellent method of cooking
meats, especially those which are somewhat tough. The
juices which exude being retained, add much to the flavor
and the nutritious qualities of the meat.

Soups are made by extracting the juices from meat
by boiling. If bones, cartilages, membranes, and tendons
are used, a soup is obtained which, though it may appear
substantial, is really in a great measure devoid of nutritious
qualities. Such soups consist in the main of gelatin, and
are altogether incapable of supporting life. The tablets
which are sold in this country and Europe as concentrated
beef tea or portable soup, are nothing but gelatin conjoined
with a very small portion of extract of meat. They are
therefore inapplicable for the purposes for which they are
sold.

In order to make good soup, lean meat should be taken
and cut into pieces the size of half an orange. These
should be put into cold water, which should be very grad-
ually raised to the boiling point, and should then be

514 A TREATISE ON HYGIENE.

allowed to simmer for two or three hours at least. By
this process the juices are thoroughly extracted from the
meat and become incorporated with the water. The meat
consists of musculin alone, and though palatable and useful
when eaten with the soup, does not possess all the qualities
as an article of food which it had before being cooked.

On this property of meat to part with its albuminous
and saline constituents to water depends the process by
which extracts of meat are made. Lean beef, for instance,
is cut into small pieces and thoroughly extracted with
water the temperature of which is not allowed to rise as
high as the coagulating point of albumen, (about 150°
Fahrenheit.) The meat is then subjected to pressure, so
as to remove all the juice which remains. The two
liquids are then mixed and evaporated to a sj^rupy con-
sistence. A tablespoonful of such an extract will make a
pint of rich and nourishing soup, which contains all the
nutritious elements of the beef except the musculin.

The importance of extract of beef to armies can scarcely
be overestimated. Hundreds of lives have been saved by
it on the battle-fields of the present war, and as an article
of food for the sick it is exceedingly valuable. It is en-
tirely soluble in cold water, and hence can be used where-
ever water can be procured. Even without this liquid, it
can be administered with advantage. The tablets pre-
viously mentioned are not soluble in cold w r ater.

Birds. — Many birds are used as food by man. Their
flesh does not differ essentially in composition from that of
mammals. It usually contains less water than the latter.
The remarks made relative to the flesh of mammals are
generally applicable to that of birds.

The flesh of birds is ordinarily easy of digestion, with
the exception that the flesh of water birds, from the quan-
tity of oil it contains, which is apt to become rancid, and
from the fact that it is tougher, is not so readily digested
as that of land birds.

ANIMAL COMPOUND ALIMENTS. 515

The white meat of birds owes its color to the fact that it
is in a state of fatty degeneration. It is more tender than
the dark part, but not so juicy or so highly flavored.

In regard to cooking the flesh of birds, the principles
enunciated under the last head are applicable.

Reptiles. — Very few reptiles are used as food by man-
kind. The flesh of many of them is, however, tender and
nutritious, not differing materially from the flesh of mam-
mals or birds.

In this country several species of turtle are eaten, and
are esteemed great delicacies. They are very nutritious,
and by no means indigestible for well persons. Owing to
the manner in which they are generally cooked, (with wine
and spices,) they are not suitable for the sick. In the trop-
ical parts of America, the iguana, a species of lizard, is
eaten. It is said to be very palatable and tender.

Frogs are also very tender and palatable, and are eaten
very generally by all who have once taken the first mouth-
ful. The flesh is similar, though much more tender and
luscious, to that of the chicken. It is easily digested,
and is an advantageous article of food for the sick. Gen-
erally the hind legs only are used, but I am enabled to say,
from experience, that the rest of the flesh is just as good as
that of the posterior extremities.

Fish. — Contrary to what might be supposed from a casual
examination, the flesh of fish is very similar in composition
to that of the animals just mentioned. It contains some-
what more water, less nitrogenous matters, but more phos-
phates and other salts. Fish form an excellent kind of
food, nutritious, and easily digested. The flesh of fish is
generally relished by invalids, and forms an unstimulating
diet, which should be more frequently used than it is.

By salting, the flavor of fish flesh is entirely changed,
and, as in the case of other meat, it is deprived of much of
its nutritious element. It is also rendered hard and much
more difficult of digestion.

516 A TREATISE ON HYGIENE.

At certain seasons of the year some fish become poison-
ous. This is the case with the rock-fish or striped bass,
which occasionally produces vomiting, and an eruption on
the skin resembling urticaria, after being eaten.

Before eating fish it is very necessary to ascertain that
they are fresh, that is, have not been long out of the water.
This can be determined by an examination of the gills,
which retain their bright-red color only for a few hours
after the animal is dead. It is far better, however, in the
summer season at least, only to purchase fish that are still
alive. They can be readily brought to market in boxes con-
taining sufficient water for them to live in for several hours.
Fish flesh very readily undergoes putrefaction. Fish should
be either boiled, baked, roasted, or broiled. Small fish are
very generally fried, and are palatable enough when so
cooked, but they are not nearly so digestible as when the
other methods are used.

Articulates. — The animals of this division, in use as
food, mainly belong to the Crustacea, though in some parts
of the world certain insects are eaten. In the first-named
class are included the lobster, the crab, the shrimp, the
prawn, and the craw-fish. The flesh of these animals is
similar in composition to that of fish, but more difficult of
digestion. In some cases violent intestinal irritation is ex-
cited by this species of food, and an eruption on the skin
resembling urticaria is occasionally produced.

The flesh of the Crustacea readily undergoes putrefac-
tion, and if eaten in that condition may give rise to very
alarming symptoms. Great care should therefore be taken
to insure its being in good condition before it is allowed to
come to the table. When fresh it rarely causes any dis-
order of the digestive system, if eaten by well persons and
in moderation.

Insects are not eaten by civilized nations. Several tribes
of Indians in the western regions of the United States eat

ANIMAL COMPOUND ALIMENTS. 517

a species of grasshopper, which is found there in great
abundance. The insects are pounded in a kind of mortar
and made into cakes, which are baked. Those who have
eaten them assert that they are of pleasant flavor and
highly nutritious.

Mollusks. — The animals of this class which are used in
this country as aliment are the oyster and the clam. In
Europe several kinds of snails and other species of shell-fish
are eaten.

Oysters are nutritious, and are generally easily digested,
though there are some persons who cannot eat them with
impunity. The manner in which they are served mate-
rially influences their digestibility. Thus, if eaten raw, they
are less liable to disagree than if cooked; and if roasted or
stewed, are more wholesome than when fried. Made into
soup, a very nourishing liquid is obtained. For this pur-
pose the oyster should be cooked in its own liquor, sufficient
water being added to prevent scorching.

Clams are very indigestible for almost all persons, unless
chopped very fine and made into soup, and even then fre-
quently cause intestinal disturbance.

In using shell-fish as food, care should be taken to avoid
such as are not perfectly fresh. Oysters during hot weather
are soft and milky, it being the breeding season with them.
At such times they are not fit to be eaten.

518 A TREATISE ON HYGIENE.

CHAPTER XXV.

VEGETABLE COMPOUND ALIMENTS.

If we were to consider all the vegetables which are used
as food by man, this treatise would be extended far be-
yond its prescribed limits. We shall therefore merely re-
fer to those principal vegetable substances which are really
types of the others.

Among the most important, if not the chief vegetable
aliments, are the cereal grains. In general features these
resemble each other. Thus they all contain starch, gluten,
sugar, gum, mineral salts, woody matter, and water. They
therefore embrace in their composition all the alimentary
principles already mentioned, and are better adapted for ali-
mentary purposes than any other compound article of food.

The cereal grains are mainly used as food in the form of
bread, a substance which is almost universally employed
by all nations, from the most barbarous to the most highly
civilized.

Wheat is the most important of these grains, not only on
account of the extent to which it is cultivated, but also be-
cause it is more available for all the wants of the system, in
regard to food, than any other of the grains. It contains
from 10 to 15 per cent, of gluten, from 56 to 75 per cent, of
starch, and from 4 to 9 per cent, of sugar, besides earthy
phosphates. It is perfectly possible, therefore, for man to
live a long time on wheaten bread, and with less derange-
ment of his system, than upon any other single article of
food.

In the manufacture of wheat flour, the grains are ground

VEGETABLE COMPOUND ALIMENTS. 519

and sifted, so as to separate the bran or husk from the true
nutritious part. In this process, as ordinarily conducted,
there can be no doubt that a great portion of the gluten,
which occupies the outer part of the grain, has also been
removed, and is thus lost. It has recently been ascertained
that it is perfectly possible to separate the outer lamina of
the bran without interfering at all with the gluten cells.
Flour made with wheat thus prepared is of course to be
preferred to that made from grain from which, with the
bran, the testa and a large quantity of the gluten have
been abstracted. It is said to contain over 18 per cent,
of gluten.

Wheat bread is of two kinds — fermented and unfer-
mented. Fermented bread is made by mixing with the
dough, yeast, which is gluten in a state of incipient decom-
position. Through the influence of the yeast a part of the
starch of the flour is converted into dextrin, and this fur-
ther into grape sugar. A portion of the sugar thus pro-
duced undergoes decomposition into carbonic acid and alco-
hol, and if the action is allowed to continue sufficiently
long, lactic, butyric, acetic, and other organic acids are
formed.

But something else is accomplished. Through the pro-
duction of carbonic acid the dough becomes filled with
innumerable bubbles of this gas, and when the loaf is put
into the oven and baked, the crust which forms on the out-
side prevents the escape of the gas. The bubbles expand
under the influence of the heat, and the bread in conse-
quence becomes light. This is a most important quality in
bread, as it enables it to be more rapidly acted upon by the
digestive juices. If a piece of such bread is squeezed so as
to break up these vesicles, it is always more difficult of
digestion than bread which has not been subjected to this
action. Thus I caused a dog, in which I had formed a gas-
tric fistula, to eat successively equal weights of vesiculated

520 A TREATISE ON HYGIENE.

and compressed bread. I found that the first was di-
gested in two hours and fifteen minutes, while the latter
required three hours and thirty-five minutes to be perfectly
digested. It is on account of the facility with which warm
bread is compressed in breaking or cutting it, and by the
action of the teeth, so that the vesicles become obliterated,
that it is so much more indigestible than bread which has
been baked a few hours.

The preparation of fermented bread is attended with
many difficulties, so much so that good bread is a rarity,
and as an article of domestic manufacture is still more
seldom met with. This is owing to various causes, some-
times to the bad quality of the flour, at others to the condi-
tion of the yeast used, and again to the imperfect kneading
or baking. It has therefore been an object to devise a
method of bread making which would always, with a fair
article of flour, secure good bread.

One process consists in adding carbonate of soda to the
flour and hydrochloric acid to the water. When the two
are mixed so as to make dough, carbonic acid gas is set free
and chloride of sodium remains. The difficulty of this pro-
cess is that, as the apportionment of the amount of carbon-
ate of soda and hydrochloric acid must ordinarily be left to
persons who will not appreciate the necessity of mixing
them in determinate quantities, it will often happen that
one or the other will be in excess, and thus the bread will
be, in a manner, spoiled.

To obviate this liability, yeast -powders are manufac-
tured, and are used extensively throughout the United
States. They consist of tartaric acid and carbonate of soda,
mixed in the proportions to form tartrate of soda. The
only difference between this method and that last described
is, that tartrate of soda is formed instead of chloride of
sodium. It can scarcely be considered desirable to ingest
as large a quantity of tartrate of soda, daily, as would be

VEGETABLE COMPOUND ALIMENTS. 521

contained in the quantity of bread eaten in a similar period,
and hence, though bread thus made is light and of apparent
good quality, it is not such as should be habitually used.

Aerated bread, as it is called, is made by mixing the
flour with water which has been strongly impregnated with
carbonic acid, and then baking in the usual way. There
are several manufactories of aerated bread on the large scale
in this country, and the bread is generally liked by those
who use it. It is less apt to become stale than the fer-
mented bread, and is palatable and easily digested.

Another process is that devised by Prof. Horsford, of
Harvard University. We have seen that in removing the
bran from the wheat a great part of the gluten is also
removed. Now in this gluten the principal portion of the
phosphatic salts is contained, and through their abstraction
the wheat is deprived of a part of its nutritious quality,
these salts being essential to the formation of bone and
likewise of nervous and other tissues. Professor Horsford
proposes not only to supply the phosphates thus removed,
but at the same- time cause the formation of a sufficient
amount of carbonic acid to vesiculate the bread. This is
done by the addition to the flour of a dry and highly acid
phosphate of lime and bicarbonate of soda, in such propor-
tions as will cause the formation of neutral phosphate of
lime and phosphate of soda, with the evolution of carbonic
acid gas. The bread formed by this process is made with
very little labor, is baked in about half an hour, and is ex-
ceedingly palatable. No trouble is necessary in mixing the
ingredients, as the prepared flour can readily be obtained
from most provision dealers and grocers.

In regard to the comparative healthfulness of fermented
and unfermented bread, no definite conclusion has yet been
reached. It is probable that no great difference exists be-
tween them in this respect when both are well made. The
risk of bad bread, however, is decidedly greater with the

522 A TREATISE ON HYGIENE.

fermentative process than with those in which other means
are taken to render the bread light. There is nothing to
warrant the opinion that the microscopic fungi, developed
during the fermentation, are at all injurious to health.

In baking bread, both of the fermented and unfermented
kinds, it is very necessary, in order to insure its easy diges-
tion, that it should be thoroughly cooked. Bread which
is not well baked is tough and indigestible, and never so
light as it should be.

Bread is very frequently adulterated, either for the pur-
pose of making that which is made of dark flour look white
and fine, or to give increased weight to it. The substance
used for the first-named object is alum, which, when added
to the dough, renders the bread made of inferior flour whiter
and firmer than it would otherwise be. Alum acts by ren-
dering the albumen less soluble, and by preventing the
fermentative process from proceeding too far.

The use of alum in bread is injurious, both because it
tends to conceal the bad character of the flour employed,
and because it is capable of exercising an injurious effect
upon the bread by rendering it indigestible. It is also
probable that the continued ingestion of alum is calculated
to disorder the healthy action of the digestive system.

The presence of alum in bread may be detected by tritu-
rating the suspected sample with distilled water, filtering
and adding a solution of chloride of barium to the filtrate.
If alum be present, a white precipitate of sulphate of baryta
will be thrown down.

I have several times detected alum in bread, but never
in any very great quantity.

Sulphate of copper would appear to be used in Europe to
give whiteness to bread. This is a dangerous poison, and,
though it is employed in small quantity, the effects cannot
but be injurious. I have never found it in American
bread.

VEGETABLE COMPOUND ALIMENTS. 523

Water, when added to the flour in larger amount than
is necessary, and the bread is not sufficiently baked, is an
adulterant, inasmuch as it increases the weight of the
bread without a corresponding amount of nutriment being
supplied. Sulphate of lime, chalk, and bone-dust, among
inorganic substances, and potatoes, bean flour, and other
flours, among organic matters, are occasionally used to
adulterate wheat flour. They are more readily detected
by the microscope than by other means.

Flour is often rendered unwholesome by the presence of
several forms of fungoid growths.

These consist of ergot, (Oidium abortifaciens,) smut,
(Uredo caries and Uredo segetum,) and mildew, (Succinia
graminis.) Of these ergot is most pernicious, very serious
diseases being produced by eating bread made of wheat
affected with it. It appears to exert a special effect upon
the organic muscular fiber of the capillaries, constringing
them, and thereby preventing the circulation of the blood
through the whole body. Mortification results in conse-
quence. The other species mentioned are not known to
produce any poisonous effects.

Animal organisms are also met with in wheat and wheat
flour. A species of vibrio (Vibrio tritici) infests the grain,
and a species of acarus (Acarus farinae) is found in damaged
flour. I have never seen the species of this latter genus
mentioned and figured by Hassall*

Indian-corn. — This grain is more extensively used in the
United States than in any other part of the world. It con-
tains a greater amount of starch and less nitrogenous matter
than wheat, but, in addition, includes among its components
a considerable quantity (about 8 per cent.) of a fatty oil.

Bread made of corn meal, though not so digestible as that
made of wheat flour, is nutritious, and not liable to disagree

* Adulterations Detected, etc. London, 1857, pp. 268 and 2T0.

524 A TREATISE ON HYGIENE.

with the digestive organs. Owing to the large amount of
oil which exists in it, it is very fattening. Fermented
bread is not made with corn meal. The flour is simply
mixed with water and salt and baked. Eggs are some-
times added.

Rye, buckwheat, oats, barley, and rice are other cereals
which are used as food, either as bread or in other forms.
The latter is the most easily digested, and is exceedingly
useful as an article of diet for the sick. It constitutes a
part of the ration issued to the United States troops. Oats
are very nutritious, ranking next after wheat in this re-
spect, but the flour made from them is generally considered
as somewhat indigestible. Oatmeal is an important article
of food in Scotland and other parts of Great Britain, but is
not eaten by the inhabitants of the United States, probably
on account of the great abundance of other more palatable
food.

In regard, further, to the cereal grains, it would be in-
teresting to go more at length into their consideration, but
for the reason stated this must be deferred. The remarks
which have been made relative to wheat and bread are
generally applicable to them and to the bread made from
their flour.

Peas and beans belong to the leguminous seeds, and con-
tain both nitrogenous and starchy matter. The former
is casein, not differing in composition from the casein of
milk. They are not very nutritious, and are apt to cause
indigestion. They should not therefore be allowed to the
sick. In these seeds we have an instance of aliment con-
taining a large proportion of nitrogen and yet which does
not possess a high value as nutriment. As Liebig asserts,
this is probably owing to the deficient amount of phos-
phates which they contain. Beans are a part of the army
ration. They are generally used to make soup with, and
if well cooked are ordinarily of easy digestion in this form.

VEGETABLE COMPOUND ALIMENTS. 525

Among the roots and tubers used as food, the principal
are the potato, the turnip, the beet, the carrot, and parsnep.

The potato contains a large proportion of starch, and is
an excellent article of food as an adjunct to other sub-
stances. It is not, however, to be used as an exclusive
aliment, and cannot be so employed without depravation
of the blood being the consequence if the attempt is long
persevered in.

Potatoes are an excellent antiscorbutic, especially when
eaten raw. They are issued to the army as a component
part of the ration.

Beets are wholesome and palatable. Though they con-
tain no starch, they possess a substitute in sugar.

Turnips, carrots, and parsneps are not very digestible,
and to many persons, on account of the volatile oil they
contain, not very palatable.

There are many other vegetable substances used as food
by man, but which cannot now receive notice. Leaving
the further consideration of them, we come in the next
place to the accessory articles of food, which, in a hygienic
point of view, are extremely interesting, but which have
not, until late years, received that attention from physi-
ologists and hygieists which their importance demands.

526 A TREATISE ON HYGIENE.

CHAPTER XXVI.

ACCESSORY FOOD.

Under the head of accessory food, (a term first, I be-
lieve, used by Dr. T. K. Chambers,) I propose to treat of
that very important class of substances which, though of
doubtful or low status as aliments, are yet extremely use-
ful, either as making the food more savory, as promoters of
digestion, or as agents for developing nervous or physical
force. The principal articles to be considered in these
connections are certain condiments — pepper, cayenne, mus-
tard, and vinegar, alcohol in its various forms, tea and cof-
fee. Tobacco, though not ingested into the stomach, is
properly embraced under this head, and will therefore be
brought under notice.

Condiments. — Condiments are those substances which
give piquancy or flavor to the food. Another effect which
they possess is that of stimulating the action of the salivary
glands and stomach by reason of their irritating qualities.

The use of condiments is not altogether to be com-
mended, although there is no doubt that when used with
discretion they are capable of being advantageous, espe-
cially in promoting the digestion of substances which would
otherwise be slowly acted upon by the digestive organs.
But it must be recollected that the continual use of irri-
tants is always productive of debility in the tissue to which
they are applied. In the case of condiments, when em-
ployed in moderation, the disturbance produced is scarcely
appreciable, and is more than counterbalanced by the good
effects which follow; but if used in excess, not only irrita-

ACCESSORY FOOD. 527

tion and inflammation of the organs with which they
immediately come in contact are excited, but other organs
are injuriously affected.

It is very easy to demonstrate the action of condiments
in increasing the amount of saliva and gastric juice secreted.
In regard to the first, it is a matter of common experience
that those substances capable of affecting powerfully the
nerves of taste cause an augmentation of the quantity of
saliva, and the same fact is readily proved by experiments
on the lower animals, as for instance the dog, as has been
done by Bernard and others. It is, however, a more re-
markable fact, and one which shows the intimate sympa-
thetic relation existing between the several functions con-
cerned in digestion, that whatever increases the amount of
saliva secreted, likewise increases the quantity of gastric
juice. This can be readily shown by putting any strongly
sapid substance, as for instance vinegar, in the mouth of a
dog in which a gastric fistula has been formed. In a few
seconds the gastric juice will run from the fistulous open-
ing, although no portion of the vinegar can have entered
the stomach.

This, then, constitutes the chief advantage attendant on
the use of condiments, and it is one which entitles them to
rank high in the scale as accessory articles of food.

Pepper. — This substance is the unripe fruit of the Piper
nigrum, a vine growing in the East Indies. Its appearance
is familiar to every one, and need not therefore be particu-
larly described. The odor of the berries is somewhat aro-
matic, and the taste sharp, hot, and acrid. If pepper is
taken in large quantity into the stomach it affects the gen-
eral circulation, causing increased action of the heart and
blood-vessels. Pepper is a wholesome stimulant to diges-
tion, and has recently been very properly added to the
ration of the American soldier.

Pepper contains an active principle — piperin — an essen-

528 A TREATISE ON HYGIENE.

tial oil, and an acrid resin. The former has had some
repute as an antiperiodic, but its powers in this respect are
scarcely worthy of consideration.

The extent to which pepper is used as a condiment
causes it to be frequently adulterated. The microscope
affords the most ready means for detecting its sophistica-
tion. According to Hassall,* linseed meal, mustard husk,
wheat flour, pea flour, sago, rice flour, pepper dust, and
woody fiber are used as adulterants of powdered pepper.
I have examined a good many samples, but have never
detected any foreign matter but linseed and starch.

Cayenne. — Cayenne pepper is prepared from several
species of capsicum, of which the C. annuum is the prin-
cipal. This latter, though a native of the tropical regions
of Asia and America, is cultivated throughout the greater
part of the world. The fruit, which is a small berry, is
the part used. It is, when ripe, of a bright-red color.

Cayenne pepper, which is the powder of the several
species of capsicum, is not only a condiment, but is a
powerful stimulant, much more so than black pepper. It
is a very useful addition to food when not too liberally
used, and it should always be employed with those sub-
stances which are liable to produce flatulence.

Capsicum owes its peculiar properties to the presence of
an active principle, capsicin, which is an acrid oleo-resin.

The adulterations of cayenne pepper are very numerous.
Hassalrf states that of twenty-eight samples he examined,
twenty-four were sophisticated — red-lead, Venetian red,
vermilion, and rice being the principal substances used for
this purpose. According to Normandy,! brick-dust is fre-
quently used as a sophistication. I have very seldom

* Op. cit, p. 364. f Op. cit., p. 372.

% Commercial Hand-Book of Chemical Analysis. London, 1850,
p. 155.

ACCESSORY FOOD. 529

found the cayenne pepper purchased in this country to be
adulterated. Once I found a sample to contain starch, and
once red ochre.

Mustard is very commonly used in the United States as
a condiment. The flour, in which form it is employed, is
produced from the seeds of the Slnapis nigra and Sinapis
alba, the former usually predominating. The black mus-
tard is extensively cultivated in the United States, espe-
cially in Kentucky. So far as my experience goes, the
native article is very seldom adulterated.

For table use, mustard flour is generally mixed into a
paste with water, to which a little vinegar and salt are
added. It is not ordinarily used with vegetable food, ex-
cept those substances which are eaten as salads. It is an
excellent condiment, and at the same time is gently stimu-
lant to the general system. It contains a volatile oil, to
which its peculiar properties are mainly due, but this is
only found in the black mustard seed, the white containing
a more volatile oil, which, however, does not pre-exist in
it, but which is readily formed under certain circumstances.

Hassall found that forty-two samples of mustard par-
chased in London, and submitted by him to examination,
were adulterated with wheat flour and turmeric. I have
examined a number of specimens of foreign ground mus-
tard, and have found them all adulterated with wheat flour,
and many of them with turmeric in addition. The black
Kentucky mustard I have never found adulterated, but
one sample ground in New York I found to contain chalk
and turmeric, and another gypsum.

Vinegar is a dilute solution of acetic acid in water, pre-
pared by the fermentation of infusion of malt, cider, or
wine. In addition to acetic acid, which is the essential
constituent, vinegar contains coloring matter, gluten, sugar,
malic acid, 'tartaric acid, and alcohol.

Vinegar is extensively used not only as an addition to

530 A TREATISE ON HYGIENE.

certain kinds of food, but also as a preservative of various
vegetable substances, which, when thus prepared, are called
pickles. It forms a part of the ration of the American sol-
dier. It has been reported to possess antiscorbutic proper-
ties, but it is entitled to no such reputation. As a promoter
of digestion its virtues are worthy of notice, and it consti-
tutes an agreeable addition to certain articles of food.

Vinegar is adulterated to a considerable extent with sul-
phuric acid, many samples consisting of nothing but water
and this acid, the mixture being colored with burnt sugar.
I have met with liquids which were sold for vinegar which
did not contain a particle of acetic acid. For the detection
of sulphuric acid in vinegar, a solution of chloride of barium
or nitrate of barytes is added to the suspected liquid. If
sulphuric acid be present, a white precipitate will be thrown
down. If the test liquor is added in excess, the whole of
the sulphuric acid will be separated, and may be quanti-
tatively determined by weighing the sulphate of baryta
produced.

Sulphuric acid is also readily detected by the process
described by M. Menge.* A small quantity of solution of
sugar in water is placed in a porcelain capsule or saucer
and a small portion of the suspected vinegar added. Heat
is now applied, and so managed as not to cause the forma-
tion of caramel through its agency. If the sugar becomes
carbonized toward the end of the process, the existence of
sulphuric acid in it is certain.

Alcohol and its Compounds. — The propriety of the
use of alcohol, as a beverage, has been a subject of discus-
sion for many years past; but few who have participated in
it have considered the matter in its true light. The chief
reason why the advocates of a total prohibition of the em-

* Histoire des Falsifications des Substances Alimentaires et Medica-
mentaires, etc., par Hm*eaux. Paris, 1855, p. 636.

ACCESSORY FOOD. 531

ployment of alcoholic liquors have been unable to carry
conviction to those to whom they have addressed them-
selves, is that their remarks have mainly consisted of in-
vectives, and that whatever facts they have brought for-
ward have been altogether based upon the immoderate use
of the agents in question. No one can for a moment deny
that alcoholic liquors, when used in excessive amount, are
not only injurious to the individual, but are also in the
highest degree pernicious to society. That is not a subject
for discussion, for there is but one conclusion to be arrived
at. We can even go farther, and admit that there are cer-
tain alcoholic beverages — such as the distilled liquors,
whisky, brandy, rum, etc. — which, when taken habitually,
though in moderation, by healthy persons, exert a more or
less injurious effect, varying according to the quantity im-
bibed and the constitution and temperament of the indi-
vidual. It is also undoubtedly true that even fermented
liquors — wine, porter, ale, etc. — when used in excess, lead
to results in many cases which are decidedly abnormal in
their character.

But are such facts to influence us against the proper use
of all beverages which contain alcohol? Do we refuse to
use cayenne pepper and mustard, because they contain
essential oils, which are far more deleterious than alcohol,
a few drops sufficing to cause death? Do we banish onions
from the list of aliments, because a highly poisonous vola-
tile oil can be obtained from them? Do we reject mutton,
because some one has killed himself by eating too heartily
of mutton-chops ? Now these are the conclusions to which
we must come if the use of alcoholic liquors is to be en-
tirely prohibited because, when taken in excess, they lead
to disease and death. Their absurdity is so palpable that
it is scarcely worth while to discuss the matter further; but
as I think it is of the utmost importance that proper views
should prevail relative to this subject, I shall point out

532 A TREATISE ON HYGIENE.

briefly some of the fallacies which have been brought for-
ward in regard to it, and also the principal hygienic ad-
vantages to be derived from the proper employment of the
liquids containing alcohol.

The experiments of Dr. Percy* have been often brought
forward as proving something in regard to alcohol which
was not true of any other substance. This observer in-
jected strong alcohol into the stomachs of dogs. The quan-
tity varied from two to six ounces. Death followed, and
upon examining the blood and brain for alcohol it was
always found. The presence of alcohol in the blood and
brain, to those who look superficially or ignorantly at the
matter, has rather a horrible aspect; but when we know
that there is no substance capable of being absorbed by the
stomach and intestines which cannot also by proper means
be detected in the blood and viscera, the subject loses much
of its striking character. Dr. Percy used alcohol of 850°
specific gravity, which represents a mixture containing
about 80 per cent, of absolute alcohol. As the strongest
brandy and whisky contain but about 54 per cent, of alco-
hol, the concentrated character of the liquor used by Dr.
Percy is at once seen. In one case six ounces were passed
into the stomach of a dog, a quantity amply sufficient to
cause death in an adult man.

The amount of essential oil present in onions is extremely
small, far less in proportion than the quantity of alcohol
contained in the mildest wines; and yet we cannot eat an
onion without this oil passing into the blood, and impreg-
nating the air expired in respiration with its peculiar odor.

Other physiologists have detected alcohol in the blood
and viscera after its ingestion into the stomach. MM.
Bouchardat and Sandrasf recognized alcohol by the odor

* An Experimental Inquiry Concerning the Presence of Alcohol in the
Ventricles of the Brain, etc. London, 1839.

f Annales de Chiraie et de Physique, 1847, tome xxi. p. 448.

ACCESSORY FOOD. 533

in the blood of dogs which they had caused to swallow it,
and in the blood of a man in a state of intoxication. MM.
Lallemand, Perrin, and Duroy,* in a series of excellent re-
searches, demonstrated its presence in various tissues of the
body; but, ignorant of Percy's investigations, appear to
think that they were the first to isolate it.f

I have several times performed experiments with refer-
ence to this point, and have never failed to recognize the
presence of alcohol in the blood, brain, the stomach, the
expired air, and the urine of dogs to which I had adminis-
tered strong alcohol; but when using liquids containing
from 8 to 15 per cent, of alcohol, such as the German,
French, and Spanish wines, I have never been able to find
it in the solids, though detecting it in the products of res-
piration, by the solution of bichromate of potassa in sul-
phuric acid, as employed by MM. Lallemand, Perrin, and
Duroy, a test which they lead us to infer is of their own
discovery, but which was suggested and used by MasingJ
in 1854.

We see, then, that alcohol, like other substances, is ab-
sorbed into the blood, and exerts its influence on the system
through the medium of that fluid. In the next place, we
have to inquire relative' to the effects which it thus pro-
duces.

Pure alcohol is a violent poison. In the dose of less than
one ounce I have seen it cause death in a medium-sized dog,
and many cases are on record of fatal effects being imme-
diately produced in the human subject after comparatively
small quantities had been swallowed. When diluted, its
effects are not so rapidly manifested, and in this form, when
taken in sufficient quantity, the condition known as intoxi-

* Da Role de l'Alcool et des Anesthesiques dans l'Organism. Paris,

1860.

f Op. cit., p. 8.

I De mutationibus spiritus vini in corpus ingesti.

534 A TREATISE ON HYGIENE.

cation is produced. Previous to this point being readied,
the nervous and circulatory systems become excited, the
mental faculties are more active, the heart beats fuller and
more rapidly, the face becomes flushed, and the senses are
rendered more acute in their perceptions. If now the fur-
ther ingestion be stopped, the organism soon returns to its
former condition without any feeling of depression being
experienced; but if the potations are continued, the com-
plete command of the faculties is lost and a condition of
temporary insanity is induced. If further quantities are
imbibed, a state of prostration follows, marked by coma and
complete abolition of the power of sensation and motion.
Such is a brief outline of the obvious symptoms which
ensue upon the use of alcoholic liquors in considerable
quantities. When taken in amounts less than are suffi-
cient to induce any marked effect upon the circulatory and
nervous systems, there is, nevertheless, an influence which
is felt by the individual, and which is mildly excitatory of
the moral and intellectual faculties.

But besides these perceptible results of the use of alco-
holic liquors, there are other physiological effects which
flow from their use, far surpassing in importance any that
have been named, and which mainly render the substances
in question useful as aliments.

We have already passed in review the principal phe-
nomena connected with the retrograde metamorphosis of
the tissues of the body. We know that a certain amount
of tissue is decomposed with every functional action of the.
organ to which it belongs, and we at once perceive that,
were it not for the formative processes which are going on,
whereby new material derived from the food is deposited,
to take the place of that which is removed, death would
very soon result. It is often important to arrest this de-
struction of tissue, without at the same time lessening the
force which would otherwise be derived from its continu-

ACCESSORY FOOD. 535

ance; or it may be desirable to obtain a great amount of
force from an individual in a limited period. In alcohol
we have an agent which, when judiciously used, enables us
to accomplish both these ends, together with others scarcely
less important, which will be alluded to more at length
hereafter. The operation of alcohol will be best illustrated
by an example.

Let us suppose that a plowman, laboring twelve hours
a day, upon a diet consisting of ten ounces of meat and six-
teen of bread, finds that he loses weight at the rate of one
ounce per day. Now, in order to preserve his life, he must
either take more food or he must lessen the waste of his
tissues. Meat and bread are both expensive, and he finds
it difficult to obtain them, or, what is not at all improbable,
the quantity which he eats is as much as he has any appe-
tite for. The alternative which presents itself to him is
that of working less. If he is his own master, this would
be a very excellent way of getting rid of the difficulty. He
would shorten the period of his labor to ten hours, and
then, instead of losing weight, he would perhaps gain an
ounce a day. But it may happen that this alternative is
not' open to him — he must work twelve hours a day. In
this condition of affairs he takes a mug of porter or a glass
of wine, or what would be worse, a dram of whisky, after
his mid-day meal. He finds that he is pleasantly exhila-
rated, his vigor is increased, and he labors on to the close
of his task contentedly, and when it is concluded, is in
better spirits and less fatigued than he has been before
when his day's work was ended. He returns to his home,
and on weighing himself, finds that he has lost but half an
ounce. He repeats his beverage the next day; like results
follow and, when he weighs himself, he ascertains that he
has lost nothing. The inference therefore is, that the bever-
age he has imbibed, or some constituent of it, has retarded
the destruction of his tissues, and has itself aided in sup-

536 A TREATISE ON HYGIENE.

plying the material for the development of the force he has
exercised in his labor.

Now it may be supposed that this is altogether a fancy
picture, that it is a theory based upon assumptions only,
like too many others which encumber science. In physi-
ology or hygiene we believe nothing but that which is de-
monstrated, and even then we do so provisionally, with the
full understanding in our minds that if to-morrow new facts
are brought forward which appear to be inconsistent with
those upon which a favorite theory rests, and which are of
greater weight, the hypothesis shall be abandoned without
hesitation. Let us see, therefore, what evidence we have
to support the view that alcohol retards the destruction of
the tissues and supplies material for the generation of force.

Many years ago, Dr. Prout ascertained that after the use
of alcohol the amount of carbonic acid ordinarily excreted
by the lungs became considerably reduced. Within the
past few years other investigators have arrived at similar
conclusions, and have extended their inquiries to the other
excretions of the system. Thus Bocker* ascertained that
under the use of alcohol not only was the amount of car-
bonic acid exhaled by the lungs lessened, but there was a
very decided diminution in the quantity of urine elimin-
ated and in the amount of its solid constituents.

My own experiments-)- tend to the same general conclu-
sions as those of Bocker. They had reference to the influ-
ence of alcohol when the food was just sufficient for the
wants of the organism, when it was not sufficient, and when
it was more than sufficient. Four drachms of alcohol were
taken at each meal, diluted with an equal quantity of
water.

During the first series, when the food was of such a char-

* Beitrage zur Heilkunde. Crefeld, 1849.
f Physiological Memoirs, p. 43 et seq.

ACCESSORY FOOD. 537

acter and quantity as to maintain the weight of the body
at its normal standard, I found, as the result of experiments
continued through five da}<s, during which time 60 drachms
of alcohol had been taken, that the weight of my body had
increased from 226 - 40 pounds to 226*85 pounds, a difference
of *45 of a pound. In the same period, the amount of car-
bonic acid and aqueous vapor exhaled from the lungs had
undergone diminution, as had likewise the quantity of urea
and its solid constituents.

During these experiments my general health was some-
what disturbed. My pulse was increased to an average of
ninety per minute, and was fuller and stronger than usual,
and there was an indisposition to exertion of any kind.
There were also headache and increased heat of skin.

The inference to be drawn from these experiments cer-
tainly is that, when the system is supplied with an abund-
ance of food, and when there are no special circumstances
existing which render the use of alcohol advisable, its em-
ployment as an article of food is not to be commended.
But there are two facts which cannot be set aside, and
these are, that the body gained in weight and that the ex-
cretions were diminished. These phenomena were doubt-
less owing to the following causes : First, the retardation of
the decay of the tissues; second, the diminution in the con-
sumption of the fat of the body; and third, the increase in
the assimilative powers of the system, by which the food
was more completely appropriated and applied to the forma-
tion of tissue.

The quasi morbid results which followed are just such as
would have ensued upon the use of an excessive amount of
food of any kind, or the omission of physical exercise when
the body has become habituated to its use. If I had in-
creased the extent of exercise taken, there is no doubt there
would not have been the undue excitement of the circula-
tory and nervous systems that was manifested.

538 A TREATISE ON HYGIENE.

The truth of these propositions is seen in the second
series of investigations, during which the food ingested was
such as I had previously ascertained involved an average
decrease in the weight of the body of -28 of a pound daily.
Under the use of the alcohol, not only was this loss over-
come, but there was an average increase of *03 of a pound
daily. The effects upon the excretions were similar to
those which ensued in the course of the experiments of the
first series.

But, unlike the first series, no abnormal results were pro-
duced in the general working of the organism. Digestion
was well performed, the mind was clear and active, and
there was no excitement of the circulatory or nervous sys-
tems; in fact, all the functions of the body appeared to act
with energy and efficiency. It is in these cases, therefore,
that the proper use of alcohol is to be commended, that is,
when the quantity of food is not such as to admit of the
due performance of such physical or mental labor as may
be necessary, or, what amounts to the same thing, when the
digestive or assimilative functions are not so efficiently
performed as to cause the digestion and appropriation of
a sufficient quantity of the food ingested to meet the
requirements of the system.

In the third set of experiments, in which more food was
ingested than was necessary, the ill effects of* the alcohol
were well marked. Headache was constantly present, the
sleep was disturbed, the pulse was increased in frequency
and force, and there was a general feeling of malaise. I
am sure that, had the experiments been continued, I should
have been made seriously ill. Notwithstanding all these
abnormal phenomena, the body continued to increase in
weight above the ratio which existed before the alcohol
was ingested, and the excretions were diminished in quan-
tity.

After such results, are we not justified in regarding alco-

ACCESSORY FOOD. 539

hol as food? If it is not food, what is it? We have seen
that it takes the place of food, and that the weight of the
body increases under its use. Any substance which pro-
duces the effects which we have seen to attend on the use
of alcohol, even though it is not demonstrable at present
that it undergoes conversion into tissue, is food. If alcohol
is not entitled to this rank, many other substances which
are now universally placed in the category of aliments must
be degraded from their positions.

But, in addition to the experiments cited, we have the
opinions of several eminent physiologists, based upon ob-
servation, to bring forward to the same effect. Thus
Liebig* affirms that "Alcohol stands high as a respiratory
material. Its use enables us to dispense with that of
starch and sugar in our food, and is irreconcilable with
that of fat.

"In many places destitution and misery have been
ascribed to the increasing use of spirits. This is an error.

" The use of spirits is not the cause, but an effect of
poverty. It is an exception to the rule when a well-fed
man becomes a spirit-drinker. On the other hand, when
the laborer earns by his work less than is required to pro-
vide the amount of food which is indispensable, in order to
restore fully his working power, an unyielding, inexorable
law or necessity compels him to have recourse to spirits.
He must work, but in consequence of insufficient food, a
certain portion of his working power is daily wanting.
Spirits, by their action on the nerves, enable him to make
up the deficient power at the expense of his body, to consume
to-day that quantity which ought naturally to have been
employed a day later. He draws, so to speak, a bill on his
health which must be always renewed, because, for want
of means, he cannot take it up; he consumes his capital

Familiar Letters on Chemistry, etc., p. 454.

540 A TREATISE ON HYGIENE.

instead of his interest, and the result is the inevitable
bankruptcy of his body."

It must be recollected that when these remarks were
originally made, the experiments, which show that alcohol
does not accelerate the destruction of the tissues, had not
been instituted. The observations, therefore, in regard to
the spirit-drinker living at the expense of his own body,
are not based upon our present knowledge.

Moleschott,* who belongs to a more modern school, takes
the other extreme, when he says : —

"He who has little must give little, if he desires to retain
as much as one who unites wealth with prodigality. Alco-
hol is a savings bank for the tissues — if the expression will
be understood. He who eats little and drinks moderately
of alcohol, retains as much in his blood and tissues as he
who, in corresponding relations, eats more and drinks neither
beer, nor wine, nor brandy."

Perhaps this view is somewhat extreme, but that it is
based upon the truth, there can be little doubt. Alcohol
retards the destruction of tissue. By this destruction force
is generated, muscles contract, thoughts are developed, or-
gans secrete and excrete. Food supplies the material for
new tissue. Now, as alcohol stops the full tide of this
decay, it is very plain that it must furnish the force which
is developed after it is ingested. How it does this, is not
clear. That it enters the blood and permeates all the
tissues, is satisfactorily proven. Lallemand, Perrin, and
Duroyf contend that it is excreted from the system unal-
tered. If this were true of all the alcohol ingested, its
action would be limited to its effects upon the nervous sys-
tem, produced by actual contact with the nervous tissues;

* Lehre der Narungsmittel. Fin* das Volk. Dritte Auflage, 1858,
p. 148.

f Op. cit.„ p. 108 et seq.

ACCESSORY FOOD. 541

but there is no more reason to suppose that all the alcohol
ingested is thus excreted, unaltered, from the body, than
there is for supposing that all the carbon taken as food is
excreted by the skin and lungs as carbonic acid.

It is not at all improbable that alcohol itself furnishes
the force directly, by entering into combination with the
products of tissue decay, whereby they are again formed
into tissue, without being excreted as urea, uric acid, etc.
These bodies are highly nitrogenous, and, under certain
circumstances, might yield their nitrogen to the construc-
tion of new tissues. Upon this hypothesis, and upon this
alone, so far as I can perceive, can be reconciled the facts
that an increase of force and a diminution of the products
of the decay of tissue attend upon the ingestion of alcohol.

Another beneficial effect produced by this agent and its
combinations is that which it exerts upon the nervous sys-
tem. Not even physical labor so exhausts the energies of
the body as the depressing emotions of the mind. Under
their enervating influence the tissues wear away, and the
body becomes enfeebled to a degree to which mere mus-
cular exercise could never reduce it. In such cases, alco-
hol, above every other agent, lessens "the wear and tear"
of the mind, increases the assimilative process, and arrests
the regressive metamorphosis of tissue, which is reducing
the strength and weakening all the functional operations of
the organism. Hence the instinctive avidity with which
those who are overburdened with care seek to drown their
sorrows in the cup. Would it not be wiser in us to yield
to the necessity, to recognize the promptings of nature, and,
instead of vainly endeavoring to cut off the only source of
consolation which many possess, try, while pointing out
the true use of alcohol, to show the danger which lurks
behind the blessing?

After severe bodily and mental exertion, the system re-
quires time to recuperate, and if the strain has been very

542 A TREATISE ON HYGIENE.

severe, there may be no reaction, and death occurs. As a
restorative agent, alcohol has no superior. It quiets the
mind, and, by its action on the functions concerned in tissue
metamorphosis, enables the organism to regain its former
condition with more safety and rapidity than if its use is
dispensed with.

No circumstance so thoroughly demonstrates the univer-
sality of the instinct which prevails for alcoholic beverages
as the fact that all nations which possess the materials
fabricate something of the kind. From the Tartar with
his koumiss, and the Mexican with his pulque, to the highly
civilized nations with the refined wines of the grape, we
have the extremes within which there are numerous grada-
tions. It is difficult to resist the force of this fact. It shows
how powerful is the craving for alcohol, and it shows how
futile must be the attempt to abolish its use.

I have deemed it proper thus to point out at length the
real hygienic and physiological advantages attendant upon
the use of alcoholic liquors. This use, like that of every
other good thing which we have, must be guided by wis-
dom. To transgress the laws of our being, in the employ-
ment of these substances, leads just as surely to punishment
as the violation of any other sanitary or physiological stat-
ute. For the offender against the law£ of man there may
be mercy, but he who outrages the laws which govern his
organism meets with inevitable retribution. There is no
exception. The punishment may not come to-day, nor to-
morrow, but it is none the less sure. If the offense is slight,
the punishment is proportionately small. One glass of wine
too much may cause a slight headache, two a fever, three an
apoplexy. Like everything else capable of producing great
good, alcohol can also cause great harm. Our object should
be to secure the one, and provide against the other.

Alcoholic Beverages. — The alcoholic liquors of which
special mention will be made, are brandy, ivlrisky, gin, wine,

ACCESSORY FOOD. 543

and the several malt liquors. All these liquids are com-
pounds of alcohol united with water in variable propor-
tions, and also having dissolved in them certain ethers,
which give to them what is called the bouquet. These
ethers undoubtedly exercise a very considerable influence
in modifying the effects which would otherwise be pro-
duced.

Brandy is manufactured from wine by distillation. Its
odor and peculiar flavor are due to a volatile oil which
comes over with the spirit. When first made, brandy has
the appearance of alcohol, as the coloring matter of the
wine remains in the retort. The color which it has when
in the market is due to burnt sugar or caramel. The very
dark brandies are dosed with a good deal of this substance,
and the pale ones with less quantities.

Good French brandy contains about 54 per cent, of alco-
hol. Even when pure, as a beverage, the use of brandy is
not to be commended, as it possesses no advantages over
wine, and is apt to produce costiveness. As a stimulant in
certain diseases, or in weak persons who cannot take suffi-
cient wine to benefit them, brandy is extremely useful,
though for such purposes it is no better than whisky.

But a great difficulty is attendant upon the use of brandy.
So generally is it adulterated, that it may be laid down as
almost a certainty that, unless the sample can be traced
throughout its whole course, from the moment it left the
still to the time it is offered for sale, the probabilities are
immensely against the fact of its being a pure article. The
greater portion of the brandy used in the United States is
made here from whisky, and nine-tenths of the rest is manu-
factured in France or England in the same way. Since the
discovery of the methods of manufacturing the essential oils,
there is very little difficulty in making a liquor which shall
closely resemble brandy, but yet has not the slightest con-
nection with the juice of the grape. Liquors called brandy

544 A TREATISE ON HYGIENE.

are thus made, which are not worth one-tenth as much as
brandy. The brandy manufactured from the Catawba grape
is perhaps the best which can be ordinarily procured in the
American market.

Whisky is the liquor obtained by the distillation of the
fermented infusion of rye, corn, wheat, or other grain. It
is also prepared, though of an inferior quality, from pota-
toes. There is not much inducement to adulterate whisky
in this country, as it can be manufactured at a very slight
cost. The natural impurities which are incident to new
whisky are much less evident as the liquor becomes older.
Fusel oil is the chief of these, and is present in all whiskies,
though to a much greater extent in that made from pota-
toes than from any other substance. It is also present in
larger quantity in those whiskies in which the distillation
has been carried to an extent greater than is necessary to
obtain a fair quality of liquor. It is a violent poison. I
caused a large dog to take one ounce of it into the stomach,
from the effects of which death ensued in forty minutes.

Fusel oil may be detected in those spirits which contain
it by the addition of a few drops of nitrate of silver, whereby,
if the mixture is exposed to the sunshine for a short time,
a brown tinge is produced. If no fusel oil be present, no
change is effected.

Whisky is an excellent stimulant in low conditions of
the system, and undoubtedly exercises a beneficial effect in
tuberculous diseases. It is issued to the troops whenever
from exposure or excessive labor it is deemed necessary.

Gin is nothing more than whisky prepared from an infu-
sion of rye or barley, to which juniper berries have been
added. To the oil of juniper, which comes over with the
spirit, it owes its peculiar odor and flavor. This substance
also gives gin diuretic properties.

Wine. — Wines differ very much from each other both in
flavor and in the quantity of alcohol they contain. It

ACCESSORY FOOD. 545

would be impossible for us to enter into the consideration
of the several interesting points connected with the manu-
facture and chemistry of wines, and we shall have to con-
tent ourselves with the chief features in relation to them
as alimentary substances.

Wines may be divided into two classes, the strong and
the light. The strong wines, such as port, sherry, madeira,
etc., contain from 15 to 25 per cent, of alcohol ; the light
wines, such as those of France, Germany, and the United
States, contain only from 7 to 15 per cent. In addition to
alcohol, there are also present in all wines bitartrate of pot-
ash and cenanthic ether, to which latter the peculiar odor
or bouquet of wine is due.

The physiological effects obtained from wine have already
been considered, so far as the alcohol is concerned, but un-
doubtedly the influence of the ether which they contain is
also to be taken into account. The action of wines is
something more than would result were they simple mix-
tures of alcohol and water. The effect is certainly not
entirely in proportion to the amount of alcohol they con-
tain, as a glass of champagne exhilarates much more than
a similar amount of sherry or madeira, which contain 50
per cent, more alcohol. Neither is the influence limited to
exciting the action of the circulatory and respiratory func-
tions or to the retardation of tissue metamorphosis. More
than any other alcoholic liquor, wine acts as a soother and
restorer, and this, when used in moderation, without the
production of any injurious effect. On the contrary, it
would appear, from observations which have been made by
many distinguished physiologists, that those who drink
good wine, with due care to avoid excess, will, other things
being equal, live longer and to better purpose than those
who entirely abstain. The views of one of the most emi-
nent chemists and physiologists which the world has pro-

546 A TREATISE ON HYGIENE.

duced, Baron Liebig,* upon this subject are so apposite that
I subjoin them without a further discussion of the point.

"As a restorative, a means of refreshment, when the
powers of life are exhausted, of giving animation and
energy where man has to struggle with days of sorrow, as
a means of correction and compensation when mispropor-
tion occurs in nutrition and the organism is deranged in
its operations, and as a means of protection against tran-
sient organic disturbances, wine is surpassed by no product
of nature or of art.

" The nobler wines of the Rhine, and many of those of
Bordeaux, are distinguished above all others by producing
a minimum of injurious after-eiFect. The quantity of wine
consumed on the Rhine by persons of all ages, without per-
ceptible injury to their mental and bodily health, is hardly
credible. Gout and calculous diseases are nowhere more
rare than in the district of the Rheingau, so highly favored
by nature. In no part of Germany do the apothecaries'
establishments bring so low a price as in the rich cities on
the Rhine, for there wine is the universal medicine for the
healthy as well as the sick; it is considered as milk for the
aged."

The wines of the United States, which are scarcely sur-
passed, many of them, in delicacy of flavor and freedom
from deleterious substances by the best wines of Europe,
are undoubtedly destined to take the place of the noxious
compounds which are now in use as whisky and brandy.
When it is possible for us to become a wine-drinking, in-
stead of a spirit-drinking people, there will be no further
occasion for prohibitory liquor laws.

For hospital use, when it is necessary to produce rapid
and full stimulation, they do not answer, owing to their
deficiency in alcohol. The only wine, until recently, used

* Familiar Letters on Chemistry, etc., p. 454.

ACCESSORY FOOD. 547

in the military hospitals was sherry. Port was stricken
from the supply table owing to the great difficulty of ob-
taining it pure; but within the last few months a very ex-
cellent wine, Tarragona port, has been used, which appears
to fulfil all the objects of port wine. It is full bodied,
sweet, and sufficiently astringent.

The adulterations of wines are very numerous, and con-
stitute altogether too extensive a subject to be properly
discussed in any other work than one specially devoted to
their consideration.

Malt Liquors. — Under this head are included ale, porter,
and the several kinds of beer which are made from malt
and hops. They are in chemical characteristics similar to
wine, as they are produced from the fermentation of
vegetable juices.

In their influence upon the human organism, malt liquors
are noted for producing more of a sedative than a stimu-
lant effect. As exciters of the appetite and as slow but
certain tonics, they are perhaps more valuable than wine.
Bocker,* who experimented in regard to the influence of
German beer, found the principal effect to be an increase
in the amount of chloride of sodium excreted in the urine.

Malt liquors, when well made and unsophisticated, are
wholesome beverages. It often happens, however, that
they are not properly prepared, and, moreover, that they
are adulterated with deleterious substances. One of the
most common, as it certainly is one of the most injurious
articles used to adulterate malt liquors, is cocculus indicus.
It is said that strychnine and opium are also sometimes
added to beer. I do not think this is the case in this

country.

Malt liquors contain from 4 to 7 or 8 per cent, of alcohol.

* Ueber die Wirkung des Biers auf den Menschen. Archiv des Yereins
fiir Gemeiushaftliche Arbeiten, u. s. w., 1854, Band i. p. 544.

548 A TREATISE ON HYGIENE.

Tea and Coffee. — It is a somewhat remarkable circum-
stance that the active principles of both these substances
should be identical in composition, thein and caffein differ-
ing in no respect from each other. But although this is
the fact, the effects of tea and coffee upon the human
organism, though similar, are yet sufficiently different for
us to draw a distinction between them.

Tea is the leaf of a plant growing in China and Japan.
Coffee is the fruit of a tree originally found in Arabia and
tropical Africa, but now growing in the East and West
Indies and South America, to which regions it has been
introduced by man.

Tea is prepared for use as a beverage by making an infu-
sion with water of the dried leaves. Coffee is made into a
drink by boiling the roasted and ground berries. In both,
the active principles are yielded; but through the roasting
process which the coffee has undergone a volatile oil
has been developed, and the conversion of the caffein into
other compounds effected. Coffee, as we use it, is very dif-
ferent from the liquid procured by acting on the unroasted
berries with boiling water. Tea is more astringent than
coffee, on account of the large amount of tannic acid which
it contains, a substance not found in coffee.

The effects of tea upon the organism have been studied
with a good deal of thoroughness. Bocker* has investigated
this subject with his customary accuracy and devotion.
He found that under the influence of tea the products of
the destructive metamorphosis of tissue ordinarily excreted
from the body were very materially reduced in quantity.
My own experiments^ are confirmatory of those of Bocker
in most respects. In lieu of water, I took thirty-two ounces

* Versuche iiber die Wirkung des Thee's auf den Menschen. Arclriv
des Yereins, etc. Band 1. 1854, p. 213.
f Physiological Memoirs, p. IT et seq.

ACCESSORY FOOD. 549

of strong tea per day, sixteen ounces at breakfast and six-
teen at tea. Through the influence of this substance the
mental faculties were rendered much more^Gctive, the pulse
was increased in frequency, and there was a strong desire
for bodily exercise, which it was difficult to repress. At
night all these phenomena were increased in intensity, and
there was a great indisposition to sleep. They generally
lasted five or six hours after drinking the tea. Previous to
these experiments I was not in the habit of drinking tea.

Upon tissue metamorphosis the influence of the tea was
well marked. The amount of urine and the proportions of
its solid constituents were diminished, and this notwith-
standing the increased quantity of nitrogen ingested and
the additional exercise of the mind, which unavoidably
attended the use of tea.

The effects of coffee, as has been said, are somewhat dif-
ferent. Julius Lehmann,* who has experimentally studied
the subject, endeavored to separate the phenomena observed
after drinking coffee into two classes — those due to the em-
pyreumatic oil, developed during the roasting process which
the coffee has undergone, and those consequent on the pres-
ence of caffein. In this he was only partially successful;
but it is very evident that, as he observes, coffee produces
two groups of effects which it is difficult to reconcile — the
exciting influence upon the brain and nervous system, and
the power it possesses of limiting the destructive metamor-
phosis of the tissues.

The results which I obtained from my own experiments^
so far as related to the quantity of urine and proportions of
its constituents, were not materially different from those
which followed the use of tea. I found, however, that the

* tjber den Kaffee als Getrank, u. s. w. Annalen der Chemie und
Pharmacie, B. lxxxvii. p. 205.
f Physiological Memoirs, p. 25.

550 A TREATISE ON HYGIENE.

influence upon the mind was much greater, and that an
amount of me nta l labor could be undertaken, without fa-
tigue, after thejffngestion of a cup or two of strong coffee,
which could not otherwise be endured without great ex-
haustion being produced. Every one in the habit of drink-
ing coffee must have noticed this effect, and many have
doubtless availed themselves of the knowledge, by taking
an extra cup when they had an amount of intellectual
labor to go through with which they desired to do well.

The use of tea and coffee in armies cannot be too highly
commended. Both are issued to the soldiers of the United
States army, and in quantities sufficient to make good and
wholesome beverages. I have often had occasion to notice
the excellent effects produced on soldiers who, after long
and fatiguing marches, perhaps during rain and snow,
reached camp well-nigh exhausted. Tired both in mind
and body, they went into their tents or about the fatigue
duties of the camp sullen and quiet. Scarcely had they
taken their coffee, than their whole demeanor was changed.
Singing, laughing, and lively conversation took the place
of their previous moroseness, and they went to bed happy
and refreshed. Baudens* says that coffee is preferred by
the French troops in the field to any other beverage, and
that it prevents the intestinal diseases so frequent in hot
climates.

Macleod,f in considering the subject of the food of the
British army in the Crimea, says: —

"I have little doubt that, if the precaution had been
taken to supply the troops every morning with hot coffee
as they went in or returned from duty, which was a step
strongly recommended as a prophylactic at Walcheren,
much of our mortality might have been avoided. It can

* La Guerre de Crimee, p. 51.

f Notes on the Surgery of the War iu the Crimea, etc., p. 34.

ACCESSORY FOOD. 551

hardly be doubted that this could have been accomplished
at the worst of times by a little management, as there are
few things more portable or more easily prepared than
coffee. The Turks place great reliance on this beverage
as a preservative against dysentery, and the French pre-
ferred its use in their army to the tea, which we employed.
If we were ordered to prescribe a dietary, the best adapted
to give rise to gastric irritation and dyscrasial disease, could
we suggest one more potent than salt pork, hard biscuit,
and raw rum?"

Nothing can be better for the system, in the way of food,
before the troops go to any work in the morning, than cof-
fee. It not only invigorates the body and lightens the
mind of its cares, but it serves to render the organism much
less susceptible to diseases, especially those of malarious
origin. Almost any article of the ration could be better
dispensed with than coffee, and men will be content for a
long time with hard bread and salt pork, if they can be
supplied with a sufficient quantity of this beverage.

Tea and coffee are both subject to adulteration. The
tea leaf is perfectly characteristic, and, when once it is
thoroughly recognized, no difficulty exists in detecting the
false leaves. The coffee berry cannot be adulterated, un-
less in its ground state, as its form, color, and other features
are such as admit of easy verification; but when roasted
and ground, it is readily sophisticated, and advantage is
very generally taken of this fact by dishonest dealers to
impose upon the community.

The tea leaf is in width about one-third its length; the
margins are serrated. In the large leaves the serration is
welf marked, and all the veins proceeding from the cen-
tral part of the leaf form a series of loops as they approach
the maroin. Microscopically examined, the tea leaf is seen
to be covered on its under surface with short and pointed
hairs. The stomata are also met with, principally on the

552 A TREATISE ON HYGIENE.

under surface of the leaf, and are formed by two semi-
ovoid al cells, which unite at their extremities, so as to
leave an aperture between them. By macerating the tea
leaves in water for a day or two, it becomes very easy to
examine it by simple inspection or by the microscope. I
have frequently found willow leaves and grass in low-priced
teas, and many other kinds of leaves are used for the pur-
pose of adulteration.

Tea leaves which have been already used are often dried
and again put in the market. They can only be detected
by the weakness of the infusion they make, or by chemical
examination.

Black tea is much more wholesome than green, as the
latter is always artificially colored, and is frequently dusted
with catechu, black-lead, ferrocyanide of iron, turmeric,
etc. Green tea should be altogether condemned as a bev-
erage. The leaf differs naturally in no respect from that
of black tea, the peculiar color and other qualities depend-
ing on the substances with which it has been coated.

Ground coffee is extensively adulterated with chicory — a
species of dandelion — rye, corn, acorns, leaves, etc. It is
difficult to detect these substances, unless by microscopical
examination or by drinking the infusions prepared from
coffee containing them. In the latter case, no one ac-
quainted with the rich, aromatic flavor and odor of genuine
coffee will fail to perceive the difference, if any of the sub-
stances mentioned have been used. What is known as
dandelion coffee is almost altogether free from coffee, and
consequently possesses but in a very slight degree any of
the beneficial properties of the genuine article.

For the detection of the adulterations of coffee the micro-
scope is necessary. By becoming familiar with the struc-
ture of the berry, no difficulty will be found in recognizing
any extraneous substances.

Tobacco. — Without going into the consideration of the

ACCESSORY FOOD. 553

botany and history of tobacco, it will be sufficient to say
that it is the leaf of the Nicotiana, a plant belonging to the
family Solanaceee, to which also the potato belongs. There
are three species of it known, all of which yield leaves
which are used by man to minister to his wants.

It has been so customary for writers to decry the use of
tobacco, that it may appear strange that a plea should be
urged in its behalf. But that it is capable of doing good
to many, when employed in moderation, does not I think
admit of doubt. If we look in the arguments of those who,
from King James the First of England to the last who has
condemned it, for any evidence of the truth of their allega-
tions, we shall find little to satisfy us. The tirades have
generally been written by those who knew nothing of the
human frame, or of the effects of tobacco upon it; and even
the few educated medical men who have given us their
views against it, have never attempted to show, by experi-
ment, its influence upon the human organism, when used
with that moderation so becoming to us in all things. It
is true the active principle of tobacco is a violent poison,
but, as we have already seen, so are the essential matters
of many other substances which we use as food without
hesitation. It is the abuse of tobacco which is to be con-
demned, and not the moderate employment of it, which,
so far from being injurious, is, on the contrary, decidedly
beneficial in the majority of instances.

The experiments which I some time since performed
upon myself,* with reference to the effects produced by to-
bacco, were sufficient to satisfy me of its great value as an
article of "accessory food." The word food, as we have
already intimated, is to be used hygienically in its largest
sense and is not to be restricted to embrace only those
substances which are taken into the stomach to be digested,

* Physiological Memoirs, p. 59.

554 A TREATISE ON HYGIENE.

and thus to enter the blood. In the proper view of the
subject, oxygen is as much food, though it enters the sys-
tem through the lungs, as is nitrogen, which enters it in
bread through the alimentary canal; and in this view it is
that I employ it with reference to tobacco, which enters the
organism through the air-passages, or by absorption from
the mucous membrane of the mouth.

The experiments, which were conducted with great care,
and during which I smoked 450 grains (nearly two cigars)
of tobacco daily, continued for five days. The food, exer-
cise, etc. remained as in a former series of investigations,
during which no tobacco was used, and during which the
weight of the body was maintained at its ordinary standard.
The results were, that I gained -07 of a pound in weight,
and that some of the products of tissue metamorphosis were
increased in quantity and some diminished. The phos-
phoric acid, for instance, was very considerably augmented,
and the urea lessened. In a subsequent series, in which
the food was insufficient to prevent the body losing weight,
tobacco, used as before, lessened the rate of loss. The
effects upon the excretions were similar to those previously
observed.

The effects upon the circulatory and nervous systems
were very apparent. The pulse was increased in fre-
quency, and there were slight, irregular actions of the mus-
cles of the eyelids, mouth, and upper extremities. The
mind was clear, and there was no headache. These sensa-
tions were succeeded by a pleasant feeling of ease and con-
tentment, which lasted about two hours. During the first
part of the night there was wakefulness, but this was
always succeeded by a sound and refreshing sleep. The
appetite was unaffected.

From both sets of investigations I concluded —

1st. That tobacco does not materially affect the excretion
of carbonic acid through the lungs.

ACCESSOEY FOOD. 555

2d. That it lessens the amount of aqueous vapor given
off in respiration.

3d. That it diminishes the amount of the feces.

4th. That it lessens the quantity of urine, and the
amount of its urea and chlorine.

5th. That it increases the amount of free acid, uric acid,
and phosphoric and sulphuric acid eliminated through the
kidneys.

As a soother to the mind and a promoter of reflection,
tobacco is entitled to great consideration; and I am decid-
edly of the opinion that it is beneficial to those who, like
soldiers, have a great deal of mental and bodily fatigue to
undergo. It quiets the troubled mind, and disposes it to look
with calmness on the ills which may bear harshly upon it.
But these remarks only apply to the moderate use. When
employed to excess, there is no doubt that it predisposes to
neuralgia, vertigo, indigestion, and other affections of the
nervous, circulatory, and digestive organs. Chewing should
be altogether discarded on account of the great loss it
causes in saliva, and also because it is a filthy practice.
Smoking is the only way of using tobacco which should be
practiced, and cigars, on account of their greater mildness,
are preferable to pipes.

But one of the best effects of tobacco, when used, as it
ought to be, only after meals, is that which it produces
over the secretion of gastric juice. It is very certainly
established that any stimulant substance which increases
the amount of saliva increases likewise the quantity of
gastric juice. To prove this it is only necessary to make
a gastric fistula in a dog, and to place strongly sapid sub-
stances, such as vinegar, aloes, or tobacco, in the mouth.
Although no gastric juice may be issuing from the tube in
the fistula no sooner is the substance placed in the mouth
and the effect produced on the saliva than the gastric
juice begins to flow until a very considerable quantity has

556 A TREATISE ON HYGIENE.

escaped, or as long as the action in the mouth continues.
The beneficial influence of an after-dinner cigar is there-
fore important as aiding materially in the digestion of the
food.

CHAPTER XXVII.

ALIMENTATION OF THE SOLDIER.

Haying passed in review the principal substances which
are used as food by man, the qualities which belong to
them, and the part which they severally perform when in-
gested into the system, we come in the next place to apply
to the alimentation of the soldier the facts and opinions
set forth.

When we consider the arduous nature of his service, the
exposure to which he is often subjected, the deprivations
he is obliged to undergo, and the necessity which exists for
providing by all possible means for his well-being and com-
fort, we see at once how important it is that the food of
the soldier should receive special attention from those who
are charged with the important duty of attending to his
subsistence. Governments have at all times recognized
this necessity to some extent, but it is only lately that the
subject has been considered as one of vital interest, and
that inquiry has been made in the right direction as to
how the food of the soldier can be best made available for
his wants, and of such a character as will enable him most
fully to accomplish the labor which is expected of him.

But, as generally happens in such cases, it was only after
a long series of disasters that the minds of those having
the power were brought to understand the necessity of

ALIMENTATION OF THE SOLDIER. 557

providing more generously for the subsistence of those who
risk their lives in the service of the state. Scurvy, fever,
intestinal diseases, debility, and other affections continued
for ages to increase the sickness and death rates of armies
before it was deemed worth while to supply a more nutri-
tious diet to the soldier; and even now there are nations
which leave the feeding of their armies in a great degree
to the whim or caprice of the officers immediately in com-
mand.

Perhaps no event of modern times has had more influ-
ence in causing right views to prevail in regard to this
matter than the war between the Allies and Russia, which
was mainly conducted in the Crimea. We have already
seen how great was the suffering of the allied forces in re-
spect to shelter; how they died from the poisons generated
within their own bodies, and languished in hospitals from
which air and light were in great measure excluded. It
will prove equally profitable to us if we consider the evils
which resulted from food deficient either in quantity or
quality. Macleod * in referring to this subject, says :—

" The food provided for the army during the first winter
and spring was defective both in quantity and quality.
This arose partly from unavoidable circumstances and
partly from inexperience in the officers to whose care was
intrusted the supply of the army. Salt meat and biscuit
constituted the bulk of the distribution, while rice, coffee,
and sugar were occasionally but sparingly added. §ir
Alexander Tulloch says that during December, January,
and February ' there was almost a total absence of fresh
meat, and even the sick were for many days, nay, even for
weeks, fed exclusively on salt meat, in their state a poison.'
The coffee, being served out raw and unground, was all but
useless and the ration salt pork was not always of the
best.

* Op. cit., p. 33.
36

558

A TREATISE ON HYGIENE.

" Men severely worked and constantly in a keen air re-
quire to have their physical energies sustained by a liberal
supply of such food as contains the largest amount of nour-
ishing and staple ingredients ; but in place of that the sup-
ply to our troops, besides being irregular in amount, was
insufficient for their support, and those constituents which
were most calculated to provide for their necessities were
reduced at the very time when they were most required.
Thus, in November, the ration of biscuit and that of rice
were altogether stopped, so that within one week the troops
were, in most cases, deprived of nearly half a pound of the
vegetable and farinaceous food so much required to counter-
act the salt meat diet, and this, too, when scurvy had made
its appearance."

These remarks, and others which Dr. Macleod makes
on the same subject, apply only to the earlier part of the
war, as matters were so very much improved subsequently
that he gives it as his opinion that in the whole history of
warfare no army ever fared so well as did the British.

The following table, prepared by Dr. Christison, exhibits
the quality of the food and the proportion of carbonaceous
and nitrogenous principles ingested daily by the British
soldier in the Crimea.

Ounces of nutri-
tive principles.

Whereof there is —

Carboniferous.

Nitrogenous.

1 lb. salt meat, ")

2352

692

2 oz. sugar, )
Coffee not used ; rice
uncertain ; beer none.

It needs no argument to show the insufficiency of such a
diet, which contained at least five ounces less of nutritious

ALIMENTATION OF THE SOLDIER. 559

principles than will suffice to maintain a soldier in a good
condition of health. Its deficiency is strongly pointed out
in the following extract.*

" During the following month (January, 1855) the posi-
tion of the soldier was one of increased difficulty and hard-
ship ; the efficiency of the whole army was seriously com-
promised — there was scarcely a man in the ranks who had
not fallen into a low, cachectic, reduced condition. Disease
was simply the more overt manifestation of a pathological
state of the system which was all but universal, and merely
indicated the worst grades of it; fever and affections of the
bowels represented the forms in which morbid actions were
usually presented; and while gangrene and scurvy, occur-
ring as complications, indicated too clearly those privations
and that exposure from which these diseases were mainly
derived, the absence of those inflammatory affections of
the pulmonary organs — of parenchymatous structures and
serous membranes — of articular inflammatory rheumatism,
so constantly prevalent in cold climates under ordinary cir-
cumstances of life, suggested irresistibly the conclusion
that the effects must have experienced such a complete
diversion from their ordinary form of expression, in defer-
ence to a cachectic state of the body, and a vitiated and
depraved state of the circulating fluids."

In the French army the case was no better. Jacquotf
says that the alimentation of the French troops was defec-
tive in quantity, for the soldiers used their money for the
purchase of vegetables, which they bought of the merchants
of Kamiesch, of the sutlers, the English, and even the
Piedmontese. During the winter of 1855-56, when the

* Medical and Surgical History of the British Array which served in
Turkey and the Crimea during the War against Russia, etc., vol. ii. p.
35 Presented to both Houses of Parliament by command of Her
Majesty. 1353.

f Du Typhus de l'Armee d'Orient, p. 85 et seq.

560 A TREATISE ON HYGIENE.

disastrous epidemic of typhus prevailed, the soldiers re-
ceived bread but one day in three. The biscuit issued was
difficult of mastication, especially by those affected with
scurvy, and when macerated it became pasty, mawkish,
and heavy. The intestinal juices acted upon it with diffi-
culty ; it was indigestible, gave rise to fluxes, and passed
from the bowels in large pieces, unaffected by the digestive
process. The meat was also of bad quality, and vegetables
were rarely issued, either fresh or preserved. The aliment-
ation of the French soldier was therefore deficient both in
quantity and quality. No doubt can exist that the typhus
fever which raged in the French army owed its origin, in
great part, to the bad character of the food.

Cazalas* states that the alimentation of the French army
in the Crimea was often insufficient, and always of medium
or bad quality.

In our own service, it has frequently happened that the
troops have suffered from the effects of food not perfectly
adapted to maintain the body at a fair standard of health.
Scurvy from a deficient amount of vegetables or fresh meat,
intestinal diseases from indigestible food, and fevers due to
an impoverished or toxic state of the blood consequent on
innutritious aliments, have frequently prevailed, when, with
such care as could readily have been bestowed, they might
have been prevented.

So far as the ration of the American soldier is concerned,
it has always compared most favorably with that of foreign
troops. Thus the ration of the British soldier is, when at
home stations, 16 ounces of bread and 12 ounces of un-
cooked meat; at foreign stations it is 16 ounces of bread
or 12 ounces of biscuit and 16 ounces of meat, fresh or salt.
This is charged to the soldier at Shd. per day abroad, or
4:hd. per day at home. Coffee, sugar, pepper, potatoes, salt,

* Maladies de l'Armoe d'Orient, etc., p. 38.

ALIMENTATION OF THE SOLDIER. 561

or whatever else he may need, is purchased by himself from
his own funds. It costs the British soldier, therefore, about
8 id. per day for his food, which sum is to be deducted from
his pay. In the Crimea, however, it was found necessary
to deviate from this standard, and there were issued to each
soldier daily —

Pounds. Ounces.

Bread 1 8

Biscuit 1

Meat, fresh or salt 1

Rice 2

Sugar 2

Coffee 1

Tea I

Lime-juice 1

Salt i| for every

Pepper ±j 8 men.

Rum gall. 3V

The deficiency here was in meat and vegetables. The
amount of coffee is not enough to make a sufficient quantity
of a good beverage.

For this ration a stoppage of 4kZ. was made daily against
each soldier.

At several foreign stations, as Hong Kong and the Cape
of Good Hope, rice, sugar, coffee, and salt are issued as com-
ponent parts of the rations, but not in large enough quanti-
ties, and in all, with the exception to be mentioned, fresh
vegetables are not supplied. There is no evidence, that I
can find, tending to show that the British soldier is required
to cultivate gardens, as is done with such excellent results
at all the garrisoned posts of the United States army.

There is no doubt that the allowance of meat in the ordi-
nary ration of the British soldier is altogether too small,
and that of bread can scarcely be regarded as sufficient.
The plan, too, of requiring the men to purchase their own
coffee, sugar, potatoes, etc. is exceedingly objectionable, and

562 A TREATISE ON HYGIENE.

it is strange that the precarious nature of such a source of
supply has not more fully attracted the attention of the
British Government, which, since the Crimean war, cannot
justly be accused of indifference for the welfare of its troops.
In India it would appear that the British soldier is better
fed than at other stations. His daily allowance of food is —

Pounds. Ounces.

Bread 1

Meat 1

Vegetables 1

Rice 4

Sugar 2A

Tea Of

Coffee, when tea is not used If

Salt 1

Wood 3

It is provided that the meat shall be cut up into joints,
and that those parts of which more than two-thirds are
bone, such as the ribs, shins, etc., shall be excluded. Mut-
ton is issued twice a week in lieu of beef, and the bread is
of the best quality.

This is a very liberal diet, and one with which little fault
can be found. It is perhaps deficient, or would be in our
climate, in bread and meat.

The French ration in the Crimea was —

Pounds. Ounces. Drachms.

Bread 1 10 7

and

Biscuit 3 8|

Biscuit 1 6 14|

Fresh beef 10 9|

Saltpork 8 U

Rice or beans 2 If

Salt 9

Coffee 9

Wine gill, If

Brandy gill, T \

ALIMENTATION OF THE SOLDIER. 563

The deficiency here is in meat, which in quantity is not
more than half what it ought to be. The coffee and sugar
are also by no means given in sufficient amount. In time
of peace, the ration of the French soldier is not so large as
above stated.

The ration of the Russian soldier is —

1 pound of black bread.

1 pound of meat.

1*1 quarts of kwass, a kind of beer.

3^ gills of sauerkraut.

Zh gills of barley.

12^ drachms of salt.

3-86 grains of horse-radish.

If gills of vinegar.

3 86 grains of pepper.*

This is by no means a bad diet, but 4 the bread and meat
are not in sufficient quantity.

The American soldier is better fed than any other in the
world. The ration, as established by law, consists of —

Pounds. Ounces.

Bread or flour 1 6

Fresh or salt beef... 1 4

Pork or bacon 12

Potatoes 1 3 times per week.

Rice ° 16

Coffee ° 1<6

Tea , °' 24

Sugar ° 2 ' 4

Beans ° 64 &■

Vinegar ° °' 32

Salt ° 16 "

In addition to the above, 1 pound of sperm candles, or

* These examples are taken from the Report of the Commission
appointed to inquire into the regulations affecting the Sanitary Con-
dition of the Army, etc. Parliamentary Documents, 1858, p. 425 et seq.

564 A TREATISE ON HYGIENE.

li pounds of adamantine candles, or U pounds of tallow
candles, and 4 pounds of soap are issued to each 100 rations.
Pepper has been recently added to the ration.

Extra issues are made of pickles and fruits, sauerkraut,
and other vegetables whenever in the opinion of the med-
ical officers they are necessary to the health of the troops;
and one gill of whisky is allowed in cases of excessive
exposure and fatigue.

Whenever it is practicable for the troops to bake their
own bread, flour is issued. Twenty-two ounces of flour, if
properly baked, will make about thirty ounces of bread.
The surplus flour is resold to the Government at the cost
price, and thus a fund is formed by each company, which
is used for the purchase of such additional articles of food
or comfort as may be desired. In time of peace, company
gardens are cultivated at every military post, so that it
scarcely ever happens that there is any deficiency of food,
either in quantity or quality. Fresh meat is issued as often
as the commanding officer may direct — generally about four
times a week.

Since the commencement of the present rebellion, the
armies of the United States have been fed as no armies
have ever been fed before in time of war. This is proven
by the healthy condition of the troops, wherever the influ-
ence of a bad climate has not been in force. Scurvy, for
instance, one of the first diseases to make its appearance
when the food is of inferior quality, has prevailed to so
slight an extent that the occurrence of an occasional case
excites attention. When we compare the condition of our
troops, in this respect, with that of other nations during
extensive warlike operations, we may well congratulate
ourselves on the difference.

After providing that the food shall be nutritious, the
next point to attend to is to insure due variety. Even the
first consideration is scarcely more important than this, and

ALIMENTATION OF THE SOLDIER. 565

no pains should be spared to render its accomplishment cer-
tain. Few facts in physiology are more completely estab-
lished than that relative to the absolute necessity of varying
the quality of the food. No matter how nutritious it may
be, it is far better to change it for food even less nutritious
than to continue an unvarying sameness.

Sick Soldiers. — The diet of the sick soldier should not
vary essentially from that of invalids in civil life. It should
be divided into several classes, according to the conditions
of the patients. Too much attention cannot be paid to this
subject by the medical officers in charge of military hos-
pitals. More, much more good will be accomplished by
providing fresh air, plenty of light, and suitable food than
by any system of medication which can be adopted. It is
not my purpose to underrate the proper use of medicinal
agents. I am fully sensible of their value — but that too
much medicine is given and too little attention paid to
hygiene, there can be no doubt.

In order that it may be shown what are the diets in use
in the military establishments of Europe, I subjoin the diet
tables of the British army, navy, and Indian service, which
are more liberal than those in force in continental hospitals.
The diet table of the United States army general hospitals
is also given. The English soldier is now, when sick, better
fed and cared for than the soldiers of any European nation.
It will be seen, from a comparison of the tables given with
that of the United States army hospitals, that every care
has been taken to provide that the diet in use in the latter
shall be of good quality, in sufficient quantity, and varied,
so as to meet the requirements of physiology and hygiene.

566

A TREATISE ON HYGIENE.

EXTRACT FROM THE INSTRUC

A Scheme of Diet for Patients in the Royal

Full Diet.

Bread It).

Beef or mutton lb.

Potatoes or greens 11).

Herbs for broth drms.

Barley drms.

Salt drms.

Vinegar drms.

Tea drms.

Sugar drms.

Milk for tea pt.

Broth pt.

Home beer (small) pts.

Or strong pts.

Beer for servants, viz. :

Nurses pts.

*Overseers of washers, washers,
and attendants on lunatics.. pts.

Foreign wine, not exceeding. ...pt.

Or porter, not exceeding pts.

At the surgeon's discretion.

Veal, Fowls, Fish. — Such quanti-
ties, in lieu of beef and mutton,
as the medical officers may pre-
scribe.

Rice or Flour Pudding. — At the
discretion of the medical offi-
cers, to patients on low or fever
diet only.

1
25
14

8
16

4
16

2
1*

Half Diet.

Bread It).

Beef or mutton oz.

Potatoes or greens oz.

Herbs for broth drms.

Barley drms.

Salt drms.

Vinegar drms.

Tea drms.

Sugar drms.

Milk for tea pt.

Broth pt.

Home beer (small) pts.

Or strong pt.

Foreign wine, at the surgeon's
discretion, not exceeding pt.

25
14

8
16

4
16

i
1

* Laborers, seamstresses, and scrubbers, etc. to have 2d. a day, in lieu of beer;
and the matron, porter, and butler lOd. a day, in lieu of rations.

N.B. — As this Scale provides liberally for each class of patients, medical officers
are carefully to avoid all deviations from it, as their duty toward the sick may per-
mit. Such patients (not exceeding six) as may be inclined, are to be admitted to
attend the weighing, measuring, etc. of the provisions in the morning, and serving
them out when cooked.

Note. — Two drachms of Souchong tea, 8 drachms of Muscovado sugar, and one-
sixth part of a pint of genuine milk, to be allowed to each patient for a pint of
tea, morning and evening.

The meat for the full and half diet is to be boiled together, with 14 drachms of
Scotch barley, 8 drachms of onions, 1 drachm of parsley, and 16 drachms of cab-
bage for every pint of broth; or at the discretion of the medical officers, 8 drachms
of carrots and 8 drachms of turnips, in lieu of the cabbage, which will make a suffi-

ALIMENTATION OF THE SOLDIER.

567

TIONS FOR NAYAL HOSPITALS.

Naval Hospitals and Marine Infirmaries.

Low Diet.

Bread oz.

Herbs for broth drms.

Barley drms.

Salt drms.

Tea drms.

Sugar drms.

Milk for tea pt.

Milk for diet pt.

Broth pt.

124

4
16

Bread oz

Or sago oz

Tea drms

Sugar drms

Milk for tea pt

Milk for diet pt

cient quantity of good broth to allow a pint to each on full and half diet, and balf a

pint to each on low diet.

Rice pudding. — Each to contain —

Rice 3oz -

Sugar l oz -

Milk tP int '

Eggs

Cinnamon 1 blade>

Flour pudding.— Each to contain—

Flour 4oz -

Sugar loz -

Milk 4 Pint.

Eggs • ]

Ginger Afew grains.

568

A TREATISE ON HYGIENE.

EXTRACT FROM THE BENGAL MEDICAL REGULATIONS.

Table of Diets for Hospitals of European Troops.

BREAKFAST.

Full diet.

Half diet.

Low diet.

Milk diet.

Spoon or fever diet.

Tea, \ oz.
Bread, 1 lb.
Butter, 1 oz.
Sugar, \ oz.

Tea, \ oz.
Bread, 1 lb.
Butter, \ oz.
Sugar, \ oz.

Tea, \ oz.
Bread, 8 oz.
Sugar, \ oz.

Tea, \ oz.
Bread, 1 lb.
Butter, \ oz.
Sugar, \ oz.

Tea, \ oz.
Sugar, } oz.

DINNER.

A pint of broth,
with barley,
greens, and
onions, and 1
lb. of meat,
either mutton
or beef.

A pint of broth,
with rice, bar-
ley, greens, or
onions, and 8
oz. of mutton,
of good and
edible quali-
ty, or a pint
of chicken
soup, with
vegetables, as
above; a
chicken or
half a fowl,
weighing,
when ready
for being
dressed, not
less than 8 oz.

A pint of mut-
ton or chicken
broth.

A pint of milk
(new) or a
pint of rice
and milk, with
\ oz. of sugar.

Bread \ lb., to
be made into
panada or
pudding, or 4
oz. of sago.

SUPPER.

A pint of rice-
gruel, with \

The same as
full.

The same as
dinner.

The same as
breakfast.

oz. of sugar,
seasoned with

ginger or nut-
meg, and a
glassful of
wine, should

any be a 1-
lowed.

In specifying the quantity of each item of meat for the several kinds of diet, it is
to be distinctly understood that meat in a raw state is intended, and not meat which
has been already boiled.

ALIMENTATION OF THE SOLDIER.

569

Articles composing the different kinds of Diet for a Day — Avoirdupois

Weight.

Full diet.

Half diet.

Low diet.

Milk diet.

Spoon diet.

Meat, 1 ft).,

Mutton, 8 oz.

Bread, 1 lb.

Bread, 8 oz., or

either beef or

of good and

for preparing

Milk, 2 pints

4 oz. sago.

mutton.

edible qual-

broth, or a

and 1 meas-

Sugar, H oz.

Bread, 1 lb.

ity, or half a

chicken for

ure for tea.

for tea, sago,

Butter, 1 oz.

fowl or a

broth.

Butter, i oz.

or panada.

Milk, 1 meas.

chicken.

Bread, 8 oz.

Sugar, 1J "

Tea, \ oz.

Sugar, 1 oz.

Bread, 1 lb.

Milk, 1 meas.

Tea, i "

Milk, 2 meas-

Tea, J "

Butter, J oz.

Sugar, 1 oz.

Rice, 6 oz. for

ures for tea

Rice, 4 oz. for

Milk, 1 meas.

Tea, \ "

rice or congee

and panada.

gruel and

Sugar, 1 oz.

Rice, 4 oz. for

water.

Salt, \ oz.

congee water.

Tea, $ "

gruel or con-

Salt, \ oz.

Nutmeg, \ dr.

Salt, £ oz.

Rice. 4 oz. for

gee water.

Firewood,

Rice, 2 oz. for

Onions, 1 "

gruel or con-

Salt, £ oz.

2 seers.

congee water.

Pepper, 1 dr.

gee water.

Onions, 1 "

Firewood,

Ginger, £ "

Salt, J oz.

Pepper, 1 dr.

2 seers.

Nutmeg, J "

Onions, 1 "

Ginger, J "

Barley, £ oz.

Pepper, 1 dr.

Nutmeg, J "

Flour, J "

Ginger, £ "

Barley, j oz.

Firewood,

Nutmeg, j "

Flour, J "

2 seers.

Barley, h oz.
Flour, | "
Firewood,

2 seers.

Firewood,

2 seers.

N.B. — The half of a fowl or chicken in the above "half diet" is to weigh 8 oz.,
exclusive of bone.

The undermentioned vegetables shall be considered as part of the authorized hos-
pital dietary, for full and half diet; the kind and quantities of those articles to be
employed for that purpose being left to the discretion of medical officers, and in-
cluded as extras in the separate statements furnished by them, and which are to be
subject to check and counter signature, as heretofore, by superintending surgeons.
It is to be understood that the quantity noted opposite each article is intended only
as the maximum to be allowed to one man on one day.

Half.

Potatoes \ ih -

Pumpkins \ "

Cauliflower \ "

Cabbage \ "

Sweet potatoes \ "

Full.
| lb.
1 "
1 "
1 "

Half. Full.

Yams i lb. fib.

Ram-tooraees | " J "

Turnips £ " 1 "

Carrots A " 1 "

The issue of such fruits as maybe procurable is also sanctioned, when considered
actually necessary, to the sick in hospital of European corps, by the commissariat,
on a separate requisition from the medical officer, countersigned by the super-
intending surgeon.

570

A TREATISE OX HYGIENE.

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ALIMENTATION OF THE SOLDIER.

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572

A TREATISE ON HYGIENE.

DIET TABLE FOR GENERAL HOSPITALS, U. S. ARMY.

Articles composing the different Diets for a Day — Avoirdupois Weight.

FULL DIET.

Articles.

Sun.

Mon.

Tues.

Wed.

Thurs.

Fri.

Sat.

Pork

Fish

jill.

5 ill.
oz.
oz.

rill,
rill.

OZ.

1-60

0-16

0-80

0-12

2-20

0-25

0-32

0-16

1-60

0-16

0-80

012

2-20

0-25

0-32

0-16

1-60

016

0-80

0-12

2-20

0-25

0-32

0-16

0-64

1-60

0-16

0-80

0-12

2-20

0-25

0-32

0-16

1-60

0-16

0-80

0-12

2-20

0-25

0-32

0-16

1-60

0-16

0-80

0-12

2-20

0-25

0-32

0-16

1-60

016

0-80

012

2-20

0-25

0-32

0-16

Rice, hominy, or Indian meal....

Salt j

Coffee ,

Tea

Milk

Butter

Flour

HALF DIET.

LOW DIET.

1-60

0-16

0-80

0-12

2-20

0-25

0-32

0-16

0-24

2-20

Bread

Rice, hominy, or Indian meah.oz.
Salt gill.

S
M
B
R

ice, farina, corn starch, or

Milk

Flour

Friday.

Codfish (in lieu of fresh
beef)

..gill.
..gill.

MILK DIET.

B
B
M

2
3

ALIMENTATION OF THE SOLDIER.

573

Diet Table for General Hospitals, U. S. Army — Continued.

CHICKEN DIET.

BEEF-TEA DIET.

Beef, lean and without

Salt gill.

0-16

0-24

Salt

.gill.

0-32

2-00
6
1

Tea

0-24

Milk

Extra Articles for Beg

ular and Special Diets.

TO BE FURNISHED BY MEDICAL

TO BE PURCHASED WITH HOSPITAL

PURVEYORS.

FUND.

Barley.

Ale, draught.

Brandy.

Beef-steak.

Beef, extract.

Butter.

Cinnamon.

Culer.

Chocolate.

Corn meal.

Cocoa.

Crackers.

Corn starch.

Eggs.

Farina.

Fish.

Gelatine.

Fruit, fresh.

Ginger.

Fruit, dried.

Nutmegs.

Ham.

Pepper.

Ice.

Porter, bottled.

Lemons.

Sugar, white.

Milk.

Tapioca.

Mustard.

Tea, extra quality.

Mutton.

Whisky.

Mutton-chop.

Wine, sherry.

Oatmeal.
Oysters.
Oranges.
Pepper.
Pickles.

Porter, draught.
Poultry.
Sugar, white.

Vegetables.

574

A TREATISE ON HYGIENE.

Diet Table for General Hospitals, U. S. Army — Continued.

FULL DIET.

Sunday.

Coffee pt.

Bread oz.

Butter oz.

Hominy, boiled . . . oz.
Molasses gill.

Beef soup pt.

Meat oz.

Bread oz.

Potatoes oz.

Other vegetables.. oz.
Rice pudding.

Tea pt.

Bread oz.

Cold meat oz.

1
6
1
2
0-32

1
12

Monday.

Coffee pt.

Bread oz.

Meat hash, with vege-
tables oz.

Beef, recently corned oz.

Or bacon, boiled oz.

Bread oz.

Potatoes oz.

Cabbage, or other vege-
tables oz.

Pickles oz.

Tea pt.

Bread oz.

Molasses gill.

16
8
4

4
1

6
0-32

■i<

Tuesday.

Coffee pt.

Bread oz.

Butter oz.

Rice, boiled oz.

Molasses gill.

Beef soup pt.

Beef soup meat...oz.

Bread oz.

Potatoes oz.

Other vegetables.. oz.

Tea pt.

Bread oz.

Fruit, stewed oz.

6
1

2
0-32

Wednesday.

Coffee pt.

Bread oz.

Meat hash, with vege-
tables oz.

Pork, ") baked or oz.

Beans,) in soup gill.

Bread oz.

Potatoes oz.

Other vegetables oz.

Indian pudding.

Tea pt.

Bread oz.

Molasses gill.

0-64

6
0-32

ALIMENTATION OF THE SOLDIER.

575

Diet Table for General Hospitals, U. S. Army — Continued.

FULL DIET— Continued.

Thursday.

la
1^

Coffee pt.

Bread oz.

Butter oz.

Ind. meal, boiled.. oz.
Molasses gill.

Semi-stewed beef

or mutton oz.

Do. do. soup...pt.

Bread oz.

Potatoes oz.

Other vegetables.. oz.

Tea pt.

Bread oz.

Cold meat oz.

1
6
1
2
0-32

1
4

Friday.

Coffee pt.

Bread oz.

Butter oz.

Fish, fresh or salt oz.

Codfish hash, with po-
tatoes oz.

Bread oz.

Beets, or other vege-
tables oz.

Pickles oz.

Bread pudding.

Tea pt.

Bread oz.

Fruit, stewed oz.

16
4

4
1

Saturday.

2 <
<

b3
PQ

Coffee pt.

Bread oz.

Meat hash, with vegetables oz.

Semi-stewed beef or mutton oz.

Do. do. soup pt.

Bread oz.

Potatoes oz.

Other vegetables oz.

Tea.
Bread.

.pt.
.oz.

Molasses gill.

12
1

6
0-32

576

A TREATISE ON HYGIENE.

Diet Table for General Hospitals, U. S. Army — Continued.

HALF DIET.

Sunday.

Coffee pt.

Bread oz.

Butter oz.

Hominy, boiled ...oz.
Molasses gill.

Beef soup pt.

Do. do. meat...oz.

Bread oz.

Potatoes oz.

Other vegetables.. oz.
Rice pudding.

Tea pt.

Bread oz.

Butter oz.

6
1

2
0-32

1
8
4
8
4

Monday.

Coffee pt.

Bread oz.

Butter oz.

Beef soup pt.

Do. do. meat oz.

Bread oz.

Potatoes oz.

Other vegetables oz.

Tea pt.

Bread oz.

Butter oz.

* f

Tuesday.

Coffee pt.

Bread oz.

Butter oz.

Rice, boiled oz.

Molasses gill.

Beef soup pt.

Do. do. meat...oz.

Bread oz.

Potatoes oz.

Other vegetables. .oz.

Tea pt.

Bread oz.

Butter oz.

2
0-32

1
8
4
8
4

Wednesday.

Coffee pt. 1

Bread oz. 6

Butter oz. ^

Beef soup pt. 1

Do. do. meat oz. 8

Bread oz. 4

Potatoes oz. I 8

Other vegetables oz. 4

Indian pudding.

Tea pt.

Bread oz. 6

Butter oz.

ALIMENTATION OF THE SOLDIER.

•577

Diet Table for General Hospitals, U. S. Army — Continued.

HALF DIET— Continued.

Thursday.

Coffee pt.

Bread oz.

Butter oz.

Ind. meal, boiled.. oz.
Molasses gill.

Beef soup pt.

Do. do. meat...oz.

Bread oz.

Potatoes oz.

Other vegetables.. oz.

Tea.

.pt.

w < Bread oz.

Butter oz.

1
6

2
0-32

8
4
8
4

6
i

Friday.

Coffee pt.

Bread oz.

Butter oz.

Codfish hash, with po-
tatoes oz.

Bread oz.

Vegetables oz.

Bread pudding.

Tea pt.

Bread oz.

Butter oz.

16
4
4

Saturday.

<
EH

Coffee pt

Bread oz.

Butter oz.

Rice, boiled oz.

Molasses gill-
Beef soup pt.

Do. do. meat oz.

Bread oz.

Potatoes oz -

Other vegetables oz.

Tea Pt-

Bread oz -

Butter oz -

1
6

2
0-32

578

A TREATISE ON HYGIENE.

Diet Table for General Hospitals, U. S. Army— Continued.

CHICKEN DIET.

LOW DIET.

Breakfast.
Tea pt.

Dinner.

Tea.
Tea pt.

1
6

12
1

6
i

Breakfast.
Tea pt.

Dinner.
Beef tea, or mutton or

Rice, farina, corn
starch, or bread,

Tea.
Tea pt.

2
1

4
2

2 !

MILK DIET.

BEEF-TEA DIET.

Breakfast.
Milk pt.

Dinner.

Tea.
Milk pt.

2
1
4
1

1
6

Breakfast.
Tea pt.

Dinner.
Beef tea oz

1
4

Tea.

CLOTHING. 579

CHAPTER XXVIII.

CLOTHING.

Clothing is worn for the purpose of protecting the body
from the effects of extreme heat or cold, and other meteor-
ological influences, and from injuries. Among civilized
nations other objects are had in view, but they are
secondary, so far at least as their origin is concerned, to
those specified.

The substances used by mankind for the fabrication of
clothing are almost entirely derived from the vegetable
and animal kingdoms of nature, very few of them being
furnished from the mineral kingdom, and such as do thus
originate admitting of but limited application. They con-
sist of vegetable fibers or hairs of animals which are
capable of being woven into textile fabrics, and skins,
which are either, by the process of tanning, converted into
leather, or are used after undergoing very little if any
manipulation. In addition, there are certain grasses which
admit of being manufactured into various articles of cloth-
ing, and silk, which is derived from the cocoon or covering
of the chrysalis of the silk-worm.

Vegetable Substances. — The principal vegetable sub-
stances employed for clothing are hemp, flax, and cotton.

Hemp is not in extensive use as a clothing material. Its
fibers are coarse and harsh unless great care is taken in its
preparation and manufacture.

Flax is converted into fabrics which are called linen.
Its applications for clothing purposes are numerous, and it
possesses several advantages over other materials, espe-

580 A TREATISE ON HYGIENE.

cially for inside garments. It absorbs the perspiration
from the body with great readiness, and consequently
allows of its free evaporation. It is an excellent con-
ductor of caloric, and hence is preferable for summer use
to cotton, and is far more agreeable. For cold weather
it is less suitable. It is a good conductor of electricity.

Cotton is more generally used as a substance for clothing
than any other belonging to the vegetable kingdom. It is
not so absorbent of moisture as linen, nor so good a con-
ductor of heat. In cold weather, therefore, or when it is
desirable to avoid the refrigeration which is produced by
the evaporation of moisture from a material in contact with
the body, cotton is to be preferred for inner clothing to any
other material.

In addition to the substances mentioned, certain grasses
are used for the production of fabrics which are employed
mainly in the manufacture of coverings for the head, and
caoutchouc, which is converted into several useful articles
of clothing. The latter is entirely impervious to moisture,
and is a bad conductor of heat. Although, therefore, it
serves effectually to protect the body from atmospheric
humidity, it is calculated, if garments constructed of it are
worn for any length of time, to produce discomfort and
even disease.

Animal Substances. — Wool is the principal substance in
use, as a material for clothing, belonging to this class. It
is obtained from many animals, but mainly from the sheep.
Woolen fabrics are bad conductors of heat, and do not
readily absorb moisture. Moreover, owing to their thick-
ness and porosity they entrap small particles of air in their
interstices, and are thus rendered more capable of retaining
the warmth of the body. Wool is principally used for
outer clothing, but it should be worn next the skin in cold
or changeable weather.

Furs, which consist of the skins of animals with the hair

CLOTHING. 581

attached, are very warm, and are used as means of protec-
tion against extreme cold.

The skins of animals when subjected to the tanning pro-
cess become converted into leather, and are then chiefly
employed, so far as the purposes of clothing are concerned,
in the manufacture of coverings for the feet. Skins, when
dressed and deprived of their hair, are also useful materials
in making certain articles of wearing apparel.

Silh is a good non-conductor of heat, and does not readily
absorb moisture. It is also a non-conductor of electricity,
and is on this account useful in certain cases as a clothing
material.

Inherent Qualities of Clothing. — There are several
considerations relative to clothing which are worthy of
attention, as influencing very much our selections accord-
ing to the objects we may have in view. It should be
light, and at the same time capable of retaining the heat
of the body in winter, while, as far as possible, excluding
the heat of the sun or of the atmosphere in summer. It
should also be of such a character as will allow of the free
passage of the exhalations from the skin, and yet not
readily absorbent of moisture from the outside. Excessive
weight in clothing is very objectionable, as tending to pro-
duce fatigue and discomfort. Imperviousness, except dur-
ing inclement weather for a limited period, is still worse,
and may, by retaining the cutaneous excretions in contact
with the body, lead to serious disease.

As affording protection against cold, the experiments of
Coulier* furnish us valuable knowledge relative to the in-
fluence exerted by various fabrics. A cylindrical vessel of
thin brass was suspended so as not to be subject to cur-

* Experiences snr les Etoffes que Servent a Confectionner les Vete-
ments Militaires. Journal de la Physiologie de l'Homme et des Animaux,
1858, tome i. p. 122.

582 A TREATISE ON HYGIENE.

rents of air. Different fabrics were in turn placed around
it, the vessel being filled with water at 50° centigrade,
(122° Fahrenheit,) and closed with a cork, through which
a sensitive thermometer passed into the water. It was
then noted how long a time was required for the tempera-
ture to fall to 40° centigrade, (104° Fahrenheit.) The
following table shows the results : —

Kind of fabric.

Time required for
cooling.

Vessel uncovered

18 min. 12 sec.
11 " 30 "
11 " 15 "
11 " 25 "
14 " 45 "

14 " 50 "

15 " 5 "

Cotton cloth for shirts

Cotton cloth for linings

Hemp cloth for linings

Dark-blue woolen cloth for soldiers' uniforms

Red woolen cloth for soldiers' uniforms

Blue cloth for soldiers' great-coats

From these observations it is seen that the uncovered
vessel cooled more slowly than when inclosed in any ma-
terial, and that thin cotton cloth is a better conductor of
heat, and heavy, blue woolen cloth a worse conductor, than
the other fabrics used in the experiments.

My own observations tend to the same general conclu-
sions as those of Coulier. I took a cylindrical brass ves-
sel, of 100 cubic inches capacity, and fitted to it a cork,
through which a delicate thermometer passed in the same
manner as did Coulier in his experiments. The textile
articles used in the investigations were made into 'cylindri-
cal bags, which fitted accurately around the vessel. The
latter was filled with water at 150° Fahrenheit, and the
time noted which elapsed till it had cooled to 140° Fah-
renheit. The results are exhibited in the accompanying
table : —

CLOTHING. 583

Kind of fabric used.

Time required for
cooling.

15 min. 11 sec.
9 " 42 "
1 " 24 "

12 " 35 "
14 " 05 "

13 " 50 "

The cotton flannel and woolen cloths were samples of
the fabrics used in the manufacture of the shirts, coats,
and trowsers of the United States troops. As in Coulier's
experiments, it is seen that the uncovered brass vessel
cooled less rapidly than when surrounded with any other
substance. This was due to the well-known fact that all
the polished metals are bad radiators of heat. The gen-
eral results are, however, not affected by this circumstance,
and the superiority of woolen clothing over that of linen or
cotton, as affording protection against cold by retaining the
heat of the body, would, if we did not already know it by
long personal experience, be sufficiently established by the
experiments cited.

As protecting agents against the effects of extreme heat,
there are also great differences to be observed between the
several substances used for clothing. Coulier, in the me-
moir referred to, gives the results of his experiments in
this direction. He took a glass tube and divided it into
pieces, each about three inches long. One end was her-
metically closed, and the tubes covered with the several
fabrics to be experimented with. A like quantity of mer-
'cury was next placed in each tube, and they were exposed
to the atmosphere in the shade, a delicate thermometer
serving to indicate the temperature. So little variation
was perceived that it was not worth being taken into prac-
tical consideration; but when they were placed in the sun,

584

A TREATISE ON HYGIENE.

the results obtained were much more striking, as will be
seen from the following table. The degrees of temperature
are according to the centigrade scale.

Substances used.

Thermometer in the shade

Thermometer exposed to the sun

Uncovered tube

Cotton cloth for shirts

Cotton cloth for linings

Unbleached hemp cloth

Dark-blue woolen cloth for soldiers' uniforms...

Red woolen cloth for soldiers' uniforms

Bluish-gray woolen cloth for soldiers' uniforms..

Red cloth for non-commissioned officers' uni-
forms

Dark-blue cloth for non-commissioned officers'
uniforms

Temperature of

tubes.

27°

30°

37-5°

35-1°

35-5°

39-6°

42°

42-5°

41-4°

43°

Difference with the
temperature of the

uncovered tube.

— 2-4°

— 2°
+ 2-1°

+ 4-5°
+ 4-5°
+ 5°

+ 3-9°

+ 5-5°

The mercury in the uncovered tube giving 3 7* 5°, it is
clear that the variation of temperature above or below this
point was due to the action of the fabric interposed between
the tube and the direct rays of the sun. It was further
found that if cotton was superposed on cloth, its effect was
to present as great a rise of temperature as took place when
the cloth alone covered the tube.

I have several times repeated Coulier's experiments rela-
tive to these points, and am satisfied of their accuracy.
As he remarks, the experiments relative to fabrics con-
sidered as means of protection against the heat of the
direct rays of the sun, are worthy of the attention of the
military surgeon. It is very evident that a white cotton
overall or duster would be a very efficacious protection
against the solar rays, for, as he has shown, a thin cotton
tissue, worn over a cloth coat, is sufficient to reduce the
temperature 7°, (12-6° Fahrenheit.) In the warm seasons
in our own climate, especially in the southern parts of the
country, it would be in the highest degree advisable to act

CLOTHING. 585

upon the knowledge which M. Coulier's observations have
afforded us.

Relative to the capacity for moisture possessed by different
stuffs, experiments are not wanting. Coulier has also in-
vestigated this point, and has given us some interesting
results.

The water which he finds a fabric capable of absorbing
he divides into two portions, that which, though absorbed
in considerable quantity, is not appreciable either by the
vision or the touch, but only by the balance or the length-
ening which takes place in the fibers. This he calls
hygrometric water. The other he designates water of in-
terposition. This changes the whole character of the
fabric; the hand applied to it experiences the sensation of
moisture, and it is possible to squeeze from it a certain
quantity of water, which can never be expelled from
a fabric charged to saturation with hygrometric water.

"When a stuff is exposed in an atmosphere saturated
with the vapor of water, it becomes saturated with hygro-
metric water. The quantity of water absorbed is constant.
To appreciate it I have first suspended pieces of the several
fabrics, two decimetres square, (about six inches,) in bell-
glasses placed over quick-lime. After twenty-four hours,
the desiccation was considered as complete. The pieces
were then immediately weighed with care, and suspended
in bell-glasses placed over water. The absorption of hygro-
metric water is very rapid at first, but toward the end be-
comes slower. I weighed the stuffs after they had re-
mained twenty-four hours over the water, and obtained the
results which are given in the following table.

" The squares of fabrics thus used were subsequently
soaked for twenty-four hours in distilled water, and then
suspended by one corner in a bell-glass placed over water,
the lower an^le being furnished with a thread to allow of
the more ready drainage of the water from the stuff. After

586

A TREATISE ON HYGIENE.

remaining twenty-four hours in the bell-glasses, the fabrics
were weighed. It is easy to see that by subtracting from
the weight obtained the weight of the stuff and of the
hygrometric water, the weight of the water of interposition
is found."

The following is the table of results obtained by M.
Coulier. The figures refer to grammes.

3 £

Fabric subjected to experiment.

o —

■a -

*t >

<" o

t- -.

*"§

■as.

3 t«

■s ^

b O

*S.2

•= 53

o o C

-=~ «;

fees

jg cS —

o3 e a
-S.2-2

d
o

u .

"S 3

2 m

.2 3

.5 5

O Ml
fc! ®

►

| °- a

►

7-55

8-50

14-40

0-95

5-90

0-126

0-781

7-75

8-40

15-40

0-65

7-00

0-084

0-903

11-19

12-90

19-40

1-71

6-50

0153

0-580

Dark -blue woolen cloth for

19-75

23-12

51-40

3-37

28-28

0-171

1-432

Red woolen cloth for sol-

19-58

23-28

55-40

3-70

32-12

0-188

1-064

Bluish-gray woolen cloth for

overcoats

20-80

24-15

52-30

3-35

28-15

0-161

1-402

Red woolen cloth for non-

commissioned officers' uni-

19-52

22-85

54-20

3-33

31-35

0-171

1-600

Dark-blue woolen cloth for

non-commissioned officers'

17-65
9-67

20-20
11-00

47-30
15-75

2-55
1-33

27-10
4-75

0-200
0-142

1-540
0-490

Fine hemp cloth for shirts...

From this table it is seen that cotton does not rank high
as an absorbent substance, and that wool is pre-eminent in
this respect; hemp and linen occupying an intermediate
place. These experiments relate to the quantity of water
which the fabrics in question are capable of absorbing when
full time is allowed for saturation. When, however, we
extend the inquiry so as to comprehend the subject of the
comparative rapidity of absorption, we find the relation
somewhat changed. From some experiments which I
made a short time since I found that pieces of cotton,

CLOTHING. 587

linen, hemp, and woolen cloths, three inches square, on
being immersed in water became saturated in the following
order: linen, hemp, cotton, wool. Every one must have
noticed how much more readily linen and hemp become
wet than cotton or wool, and it is on this account that the
former is so much cooler in hot weather when worn next
the skin than any other fabric, as it absorbs the perspira-
tion more readily and gives it off by evaporation, whereby
the temperature of the body is reduced. For affording
protection against rain, woolen cloth is preferable to either
of the other substances named, as it does not readily
become wet.

The color of clothing is also an important point to be
considered, and here we find that much has been accom-
plished toward the extension of our knowledge. In 1792
Count Rumford instituted a series of experiments relative
to the influence of color over the amount of solar heat ab-
sorbed in a given time. He found that, cxteris paribus,
black was pre-eminent as causing the absorption of more
heat than any other color.

Franklin next investigated the subject, and with his
accustomed accuracy. He exposed different colored cloths,
placed on snow, to the direct heat of the sun, and observed
the different relative depths to which they sank. Those
which sank lowest were of course those which had ab-
sorbed the greatest amount of heat. From his experiments,
Franklin came to the conclusion "that black clothes are
not so fit to wear in a hot, sunny climate as white ones,
because in such clothes the body is more heated by the sun
when we walk abroad, and are at the same time heated by
the exercise, which double heat is apt to bring on putrid,
dangerous fevers." He therefore thinks that soldiers and
sailors in tropical climates, should wear white uniforms,
and that white hats should be generally worn in summer.

In 1799 Sir Humphrey Davy performed his experiments,

588

A TREATISE ON HFGIENE.

which consisted in exposing pieces of copper, differently
colored, and on the under surface of which cerate was
spread, to the heat of the sun. His results were entirely
confirmatory of those arrived at by Franklin.

In 1833 Stark instituted his investigations, the results
of which are published in the Philosophical Transactions for
that year. His conclusions are almost identical with those
previously arrived at by Franklin and Davy, as is seen from
the following table, in which the several colors experi-
mented with are arranged in the order of their absorptive
power for heat as determined by the observers referred to :

Stark.

Franklin.

Black.
Deep blue.
Light blue.
Green.
Purple.
Red.
Yellow.
White.

Davy.

Black.
Blue.

Green.

Red.

Yellow.

White.

Colored wool.
Black.

Bark green.

Scarlet.

White.

Colored bulb of
thermometer.

Black.
Bark blue.
Brown.
Green.

Orange red.

Yellow.

White.

In the Journal of the Franklin Institute for November,
1833, Prof. A. D. Bache gives the details of a series of ex-
periments which he instituted relative to the absorptive
power of substances for heat as modified by color. Prof.
Bache concluded that the color of a substance is only of
influence in regard to luminous heat, and that if a person
keeps in the shade it makes no difference what is the color
of his clothing. As the heat given off from the body is
non-luminous, it follows that the loss of heat by the body is
not influenced by the color of the clothing. A fact which
Coulier (who evidently was unaware of Prof. Bache's ex-
periments) also established.

I have several times repeated Franklin's and Bache's

CLOTHING.

589

experiments, and have always obtained results entirely
confirmatory of theirs. I took a cylinder of brass closed
at one end, and filled it with sand. Different colored cloths
were wrapped around it, and a delicate thermometer placed
in it. The apparatus was then exposed to the direct rays
of the sun, and I noticed how long a time was required to
raise the mercury from 60° to 80° Fahrenheit, The action
of non-luminous heat was ascertained by exposing the
arrangement to the heat emitted from a gas-burner sur-
rounded by a copper cylinder.

From the facts adduced it will be seen how important is
the influence exerted by cold over the power of a substance
to absorb heat, and how correct is the instinct which guides
us to the choice of white and light-colored garments for
summer wear, and black and dark-colored clothing for

winter use.

Color likewise affects the power of a substance to absorb
moisture. Stark, in the paper already referred to, also
states the results of his experiments in regard to this point.
On a foggy night he exposed 30 grains of black wool, 30 of
scarlet wool, and the same quantity of white wool, to the
action of the atmosphere. When weighed in the morning
the black wool had gained 32 grains, the scarlet wool 25
grains, and the white wool 20 grains, deposited as frost.
A few days afterward, when there was less moisture in the
atmosphere, he repeated the experiment, using 10 grains of
each. When the wool was weighed, the black had gained
10 grains, the scarlet 9-5 grains, and the white 5 grains.

Another point relative to the influence of color, and
which may properly claim notice in a work on hygiene,
is the relative frequency with which soldiers with different
colored clothing are struck by bullets in battle. It is found
that red is the most fatal color that can be made, the pro-
portion being red 12, green 7, brown 6, and bluish-gray 5.

590 A TREATISE ON HYGIENE.

Cloth of the color now worn by the line of the army for
trowsers would be an admirable color for the whole uniform
of our soldiers.

CHAPTER XXIX.

THE HYGIENIC RELATIONS OF CLOTHING WITH THE SEVERAL
PARTS OF THE BODY.

The Head. — The covering for the head should be light,
should afford protection against inclement weather, and
should be capable of warding off the effects of the direct
rays of the sun. It should shade the eyes and face, and at
the same time protect the neck from wet and heat.

Perhaps no article of clothing is so imperfect as the hat.
Though some forms are better than others, none, either
those for males or females, can be regarded as fulfilling
all the indications required, so that it may be questioned
whether it would not be better, in a sanitary point of view,
to wear no covering for the head, than to use the uncom-
fortable and unhealthy patterns which are in vogue.
Nothing can be more misplaced than the tight-fitting dress-
hat ordinarily worn. Made of substances which are almost
complete non-conductors of caloric, they retain the heated
air in contact with the head, and thus give rise to diseases
of the scalp, and even to affections of the brain. The low-
crowned and broad-brimmed felt hat is better, and answers
tolerably well in winter weather. Straw, or the other vege-
table substances used for the purpose, are the best of all
materials for hats for summer use, and for winter, woolen
cloth.

For soldiers, the forage-cap now in use in the army, with

HYGIENIC RELATIONS OF CLOTHING, ETC. 591

a water-proof cover for inclement weather, is preferable to
any other form of head-covering. It is light, and the visor
affords sufficient shade for the eyes. The felt hat is heavy,
and has no advantages, either hygienically or aesthetically,
over the Jcejn. The head-dress of the zouaves is well
adapted to keep off the direct heat of the sun from the
head, but does not afford sufficient ventilation, and is objec-
tionable on other accounts. It is asserted by M. V. Wiaal*
that ophthalmia is much more frequent among the zouaves
and tirailleurs serving in Algiers, who wear no visors to
their turbans, than the chasseurs d'Afriqw and engineer
soldiers, who wear a cap with a large visor. The helmets
of metal and leather formerly worn by soldiers were execra-
ble, from their weight and imperviousness; and the shakos
and bearskin caps, now in use in several European armies,
are no better.

The Neck. — As a rule, the neck should be left bare.
The custom of constricting it by tight-fitting collars and
cravats is exceedingly objectionable, as preventing the free
circulation of the blood in its passage to and from the head.
Moreover, by ordinarily keeping the neck wrapped up, the
liability to take cold is very much increased when the cov-
ering is from any cause dispensed with. This is especially
the case with children, in whom the neck should always be
left exposed to the air, except in the coldest weather, when
a temporary covering may be used.

Soldiers have for over two hundred years endured the
tortures of leathern stocks and tight-fitting cravats. That
apoplexy, cerebral congestions, epilepsy, hemorrhages, ver-
tigo and other affections have been produced by this most
pernicious practice, there can be no doubt. Fortunately for

* De l'Influence des Coiffures Militaires sur le Developpement de l'Oph-
thalmie Purulente, etc. Recueil de Memoires de Medecine, de Chirurgie,
et de Pharmacie Militaires. 2eme serie, tome xvn. 1856, p. 211.

592 A TREATISE ON HYGIENE.

humanity, the stock and tight cravat are long abolished in
many armies. The leather stock is still, however, used in
the United States army, but it is low, and is not generally
worn very tight. It would be well if it were altogether
abolished, and that the principle was recognized of leaving
the neck uncovered and the head free to turn, as occasion
might require. If a cravat is worn, it should be of some
soft material, and should not be so high as to prevent the
free motion of the head. A loose silk ribbon can scarcely
be considered hurtful, so long as fashion requires some kind
of cravat to be worn.

Trunk and Limbs. — The covering of the trunk and limbs
is of especial importance, on account of the large extent of
surface which these parts of the body possess. It is there-
fore necessary to guard against atmospheric vicissitudes
with more care than requires to be exercised with other
regions.

With reference to the propriety of wearing woolen cloth-
ing next to the skin no doubt can exist, especially in regard
to those who are exposed to sudden and extreme alterna-
tions of temperature. But in order that all objection to it
should be obviated, the utmost cleanliness is necessary.
The inside clothing should be frequently changed and the
body well washed, as woolen cloths retain more effectually
than other fabrics the exhalations which are given off from
the skin. The clothing used for these parts of the body
should vary in character according to the season, and the
principles which have been stated in the preceding chapter
should be brought into application. In the military service
it would be especially desirable that a thin white cotton
or linen jacket or tunic were issued for summer use, to-
gether with trowsers of the same color and material.

It is important that the motions of the chest, abdomen,
and limbs should not be restricted by the clothing. Hence
tight waistcoats, corsets, stays, coats, and trowsers are highly

HYGIENIC RELATIONS OF CLOTIIING, ETC. 593

injurious. This is particularly to be guarded against in
children, in whom the bones are soft and easily bent out
of their proper shape.

Overcoats should always be worn when the weather is
cold enough to require them, but the use of India-rubber or
other water-proof garments is not to be commended. The
remarks of Levy* on this subject are very apposite.

"Cloaks or overalls of impermeable fabrics concentrate
the heat, and condense on their internal surface the vapor
of the cutaneous transpiration, which cannot pass through
them. It is necessary to have worn, during a day's journey
or a night in a carriage, one of these garments — which are
so much used on account of their lightness, their cheapness,
and the facility with which they can be rolled into a small
compass — to appreciate how uncomfortable and unhealthy
they are. They place an individual in motion in the con-
dition of a wet stove — the more they accumulate heat
around him, the more they expose him to be chilled. A
person wrapped in them during a rain, when the humidity
of the atmosphere is at its maximum, is steamed with
sweat, which accumulates under the impermeable garment,
while the moisture of the air steams from the external sur-
face. It is better not to attempt to isolate the individual
from atmospheric influences, but to graduate and moderate
the changes which are in action between him and the
medium, whatever it may be, in which he lives. The Coun-
cil of Health of the army, though twice consulted relative
to the introduction of impermeable garments into the ser-
vice, has persistently and with wisdom refused to recom-
mend them."

Extremities. — The proper covering of the hands and feet
cannot receive too much attention, not only because such
protection is necessary to maintain ijese organs in a condi-

* Traite de Hygiene, tome ii. 4eme edition, 1862, p. 244.

594 A TREATISE ON HYGIENE.

tion to be most useful to us, but also because if they are
subjected to sudden or extreme refrigeration, disease is liable
to be set up in some distant and important part of the body.
This is more particularly the case with the feet than with
the hands.

Gloves are made of different materials, according to the
main object to be attained in wearing them. When worn
to protect the hands from the heat of the sun, from dust
and dirt, and to keep the skin soft, pliable, and white, kid,
silk, linen, or cotton is used. The delicacy of touch so
necessary in many professions, can only be preserved by
giving attention to the protection of the hands from the
influences mentioned.

Gloves to keep the hands warm should be of wool or fur.
Buckskin or other similar material may also be used.

Boots and shoes are made of various substances, leather
being more generally used in their manufacture than any
other material. Individuals experience a great deal of dis-
comfort from wearing tight or otherwise ill-fitting shoes or
boots. The movements necessary in walking cannot, under
such circumstances, be performed without pain, and the con-
sequence is that, if they continue in operation, deformities
and diseases of the feet are produced. The proper shape to
be given to the boot or shoe is therefore a matter of very
great importance, above all to those whose occupations re-
quire them to walk or be on their feet the greater part of
the day. But it is a subject which is almost entirely disre-
garded until, by painful experience, we find the results of
our neglect exhibited in our own persons.

The principal points to be attended to in obtaining a
properly made shoe are, that the sole shall be as broad as
the foot when the weight of the body rests upon it; that it
is long enough to allow of the full play of the foot in walk-
ing; and that the uppers shall be made of a soft, pliable
substance, or have an elastic material united with it in

HYGIENIC RELATIONS OF CLOTHING, ETC. 595

such a manner as to allow the necessary yielding to take
place.

With reference to the breadth of the sole, it would ap-
pear scarcely necessary to say much, for it is a self-evident
proposition that deformity of the foot will inevitably result
if it is squeezed into a receptacle too narrow for it, and that
walking can never be comfortably performed in shoes thus
constructed. But it is a fact, that not one pair of shoes in
a hundred that are worn have soles as wide as the soles of
the feet. The consequence is, that a projection of the upper
leather takes place, and that width is thus obtained at the
cost of much pain and annoyance. Before the foot is able
to force the leather into this position much mischief is done.
Corns and bunions are formed from this cause, and from no
other.

The length of the shoe is equally as important. It is
usual for shoemakers to measure the length of the foot
while it is in repose, not knowing, as does every anatomist,
that in walking the foot undergoes considerable elongation.
Dr. Camper and Mr. Dowie,* the latter a very intelligent
shoemaker, have pointed out this fact, and it would be well
if shoemakers generally followed their precepts. The elonga-
tion which takes place is fully half an inch, and, in conse-
quence of no provision being made for this lengthening,
callosities and ingrowing toe-nails are produced.

Hard and unyielding upper leathers are calculated to
constrict the feet, and to prevent the proper motions of
these organs being performed. Elastic gussets inserted into
the shoes obviate this difficulty, and well-tanned calfskin is
sufficiently soft and yielding to answer the purpose.

The shoes of soldiers should always be selected with
oreat care, and should be made according to the principles

* The Foot and its Coverings, by James Dowie. London, 1861, pp.
14 and 96.

596 A TREATISE ON HYGIENE.

laid down. Especially is it important that sufficient breadth
should be given to the sole, and that it should not taper
too much toward the point. The heels should be low and
broad, so as to afford a firm support. High heels cause the
foot to be pushed down toward the points of the shoes, and
tend to produce flattening of the arch.

India-rubber shoes should never be worn, unless tempo-
rarily, to avoid wetting the feet. Great harm is done by
persons wearing such shoes for hours at a time, during
which period none of the cutaneous exhalation can escape.
The consequence is that the feet are kept bathed in
moisture.

Gaiters are a great protection to the ankles and instep
when low shoes are worn, and may be made capable of
affording much support to the muscles of the leg, besides
preventing varicose veins. They may be made of woolen
or linen cloth or of leather.

INDEX.

Abdomen 59

Accessory food 526

Acclimation 281

Acclimation, capacity for is not pos-
sessed in an equal degree by all

races 282

Acclimation from cold to hot cli-
mates 286

Acclimation from hot to cold cli-
mates 296

Action of fires 192

Administrative department of hos-
pitals 329

Adulterations of bread 322

Affusion 236

Agassiz, Prof, his views in regard

to centers of creation 64

Age 91

Age of recruit 19

Air, amount of required by man 438

Air, confined 422

Air of hospitals, composition of 426

Air of Madrid 151

Aissaoua, immunity of to poison of

serpents 73

Aitken, Dr 34

Albumen 470

Alcohol and its compounds 530

Alcohol a poison 533

Alcohol. Dr. Percy's experiments re-
lative to 532

Alcohol, excessive use of in cold cli-
mates injurious 300

Alcohol, experiments relative to its

effects 536

Alcohol, good effects of its use 535

Alcohol, its effect on nervous system 541

Alcohol, Liebig on 539

Alcohol, presence of in blood 533

Alcoholic beverages 542

Alimentary principles 467

Alimentation of soldier 556

Alison, Dr. Scott 40

Altitude, effect of on health 258

American race 67

Ammonia in atmosphere 161

Amylaceous principles 472

| Animal exhalations 166

Animal substances used as clothing 580

Apparatus, genito-urinary 60

Aqueous vapor in atmosphere.. 175

Arctic regions, inability of Euro-
peans to exist in 271

Army of Potomac, good health of... 461

Arnott's, Dr., flue 442

Arrangement of tents and huts 451

Arrow-root 474

Articulates as food 516

Artificial ventilation 443

Asthma, habitual 134

Atmosphere 148

Atmosphere, aqueous vapor in 175

Atmosphere, cholera cells in 173

Atmosphere, coldness of 178

Atmosphere, composition of. 148

Atmosphere, density of 195

Atmosphere, dryness of. 178

Atmosphere, epithelium in 173

Atmosphere, infusoria in 173

Atmosphere, morphological matters

in 173

Atmosphere, non-essential constitu-
ents of 151

Atmosphere, organic matter in, how

detected 172

Atmosphere, organic matters of 166

Atmosphere, physical properties of.. 195

Atmosphere, pus cells in 173

Atmosphere, vitiation of by combus-
tion of coal gas 405

Bache's, Prof. A. D., experiments

relative to color and heat 588

Bacon, Lord, on human exhalations 168

Barley 524

Barracks 446

Barracks at Fort Riley 447

Barracks, space per man in 447

Bathing 238

Bathing, importance of to troops.... 240

Bathing water 232

Bath-rooms 227

Baths 232

Baths, cold 234

(597)

598

INDEX.

Baths, hot 237

Baths, mineral 233

Baths, warm 237

Baudens' remarks on nostalgia 129

Beans 524

Beau j on Hospital, result of defective

ventilation at 432

B6gin, his definition of idiosyncrasy 89

Bennett, Dr 46

Beverages, alcoholic 542

Bilious temperament 85

Birds as food 514

Black assizes 109

Black Hole at Calcutta 154, 108

Body, period of decline of 103

Body, period of increase of. 94

Body, period of maturity of. 98

Body, why does it grow 105

Boiling 512

Boots 594

Brachet, M., his experiment relative

to intermittent fever 125

Brandy 542

Bread, adulterations of. 522

Bread, aerated 521

Bread, fermented 579

Bread, unfermented 520

Bread, wheaten 519

Brent, Mr 36, 37

British troops, condition of as to

food in the Crimea 559

Broiling , 512

Bronchitis, habitual 133

Buckle, Mr., erroneous views of rel-
ative to hereditariness 116

Buckwheat 524

Butter 508

Camps 448

Camps, overcrowding in 452

Camp police 460

Candles 399

Cane sugar 480

Capacity of chest 35

Carbonic acid, amount exhaled from

lungs v 403

Carbonic acid, amount of formed

from combustion of candle 403

Carbonic acid, amount of formed

from combustion of coal gas 404

Carbonic acid, experiment on effects

of. 153

Carbonic acid in atmosphere 151

Carbonic acid irrespirable 152

Carbonic acid not positively poison-
ous 153

Carburetted hydrogen 159

Carburetted hydrogen, experiments

relative to effects of 160

Carburetted hydrogen from coal

mines, etc 159

Cardiometer 47

Casein 470, 508

Catalepsy 57

Caucasian race. 76

Caucasian race, proclivity of to ma-
larious diseases 192

Cause of measles 182

Cayenne 528

Cereals as food 518

Cerebro-spinal axis 55

Chatin on iodine in air 155

Chest, capacity of. 35.

Chest, flattening of. 39

Chest measurer, Dr. Quain's 43

Chest measurer, Dr. Sibson's 44

Chest, relations of to structure 36

Chest, the 59

Chicken breast 39

Cholera cells in atmosphere 173

Cholera, influence of ozone in caus-
ing 164

Cholera produced by impure water.. 222

Choleric temperament 85

Chorea 57

Christison and Turner on sulphu-
retted hydrogen 157

Christison, Dr., on diet of British

army 558

Circulation, morbid habits of or-
gans of. 132

Circumference of thorax 37

Cities 261

Climate 262

Climates, cold 268

Climates, cold, inhabitants of 270

Climates, cold, vegetables of. 269

Climates, hot 264

Climates, hot, diseases of. 267

Climates, temperate 273

Climates, temperate, vegetation of.. 273

Clothing 579

Clothing, animal substances used as 580
Clothing, capacity for moisture of

substances used for 585

Clothing, color of 587

Clothing, effect of color of in battle 589
Clothing, hygrometric properties of

modified by color 589

Clothing, inherent qualities of. 581

Clothing of extremities 598

Clothing of head 590

Clothing of limbs 592

Clothing of neck V.tl

Clothing of trunk 592

Clothing, protection afforded from

cold by 581

Clothing, protection afforded from

heat by 583

Clothing, vegetable substances used

as 579

Coal gas 401

Coffee 548

Coffee, effects of 549

INDEX.

599

Coffee, use of in armies 550

Cold 201

Cold baths 234

Cold climates 268

Cold climates, food required in 272

Cold douche 236

Cold water 225

Coldness of atmosphere 178

Color of clothing, effect of in battle. 589

Condiments 520

Condiments, action of in digestion .. 527

Confined air 152, 422

Confined air, experiments on com-
position of 152

Connate diseases 118

Constipation, habitual 136

Constitution 145

Constitution, weak 52

Contamination of atmosphere from

artificial illumination 402

Cooking, manner of 512

Corn starch 470

Cotton as clothing 580

Coulier's experiments with sub-
stances used for clothing 581

Crania, Morton on 65

Cranium and scalp 54

Cranium should be carefully ex-
amined 54

Cravats, dangers of 591

Creation, centers of 64

Cryptogamic origin of diseases 175

Curvature of spine -.. 57

Davy's, Sir Humphrey, experiments

relative to color and heat 588

Davy. Sir Humphrey, on carburet-

ted hydrogen 159

Deaths among troops 14, 15

Decant at ion 247

Definition of idiosyncrasy 89

Delirium tremens 57

De Luna, Dr. Ramon, on air of

Madrid 151

Density of atmosphere 195

Desgenettes, Baron, anecdote of 460

Diarrhoea, habitual 136

Diet table British army hospitals ... 570
Diet table of British' hospitals in

India 568

Diet table of British naval hospitals 506
Diet table United States army hos-
pitals 572

Digestion, morbid habit of organs of 134

Diseases, congenital HO

Diseases, connate 118

Diseases, cryptogamic origin of 175

Diseases, hereditary • 121

Diseases, hereditary transmission of 117

Diseases, preventable., 16

Distillation 248

Douche, cold 2:5G

Drinking water 217

Dryness of atmosphere, effects of... 178
Dupuytren on sulphuretted hydro-
gen 156

Ears, the 57

Earth-eaters 488

Eating, periods for 501

Edwards' experiments 207

Eggs 508

Electricity 211

Encephalou, morbid habits of 127

Epilepsy 56

Epistaxis 133

Epithelium in atmosphere 173

Etiolation 208

European race 65

Ewart, Dr., relative to sickness of

European troops 72

Experiment relative to infusoria in

atmosphere 174

Experiments relative to substances

used as clothing 582

Extremities, clothing of 508

Extremities, lower 60

Extremities, upper 60

Eyes, the 57

False thirst 225

Fats 471

Fibrin 471

Field hospitals 387

Filters 245

Filtration 242

Fire-places 412

Fish as food 515

Flax as clothing 579

Flattening of chest 39

Flatulence, habitual 134

Flue of Dr. Arnott 442

Food 402

Food, accessory 520

Food, animal 504

Food, classification of 463

Food, dangers of ingesting an ex-
cessive amount of 497

Food, deficiency of 498

Food, essential qualities of 462

Food, necessity for varying quality

of 500

Food of American soldier 560

Food of British troops in Crimea.... 559
Food of French troops in Crimea.... 559

Food of sick soldiers 505

Food, quality of 499

Food, quantity of, as modified by

climate 495

Food, quantity of, as modified by

occupation 496

Food, quantity of, as modified by

sex 496

Food, quantity of required 494

600

INDEX.

Food required in cold climates 272

Food, vegetable 518

Fort Riley barracks 447

Franklin's experiments relative to

color and heat 587

French troops, food of in Crimea.... 559

Frying 513

Fuel 409

Fuel, comparative value of different

kinds of 409

Fungi, their poisonous effects 181

Furnaces 415

Furniture of wards 386

Gaiters 596

Gas burners, ventilation of 406

Gas, illuminating 160

Generative organs, morbid habits

of 138

Genito-urinary apparatus 60

Gin 544

Gloves 599

Gluten 471

Grape sugar 481

Grotto del Cane 154

Gum 487

Gum incapable of supporting life... 487

Habit 122

Habit, cause of 124

Habit, influence of 123

Habitations 304

Hsemadynamometer 48

Hall, Sir John 15

Head, clothing of 590

Health of Army of Potomac 461

Heat, effects of 205

Heating of hospitals 409

Heating of huts 396

Hemorrhoids 133

Hemp as clothing 579

Herapath's experiments on iodine in

air 155

Hereditary tendency 115

Highlanders, 79th, camp of in Cri-
mea 456

Hopital de la Clinique 315

Hopital Lariboisiere 333

Hopital Necker 312

Horsford's, Prof., process for mak-
ing bread 521

Hospital at Fort Schuyler 382

Hospital at Hampton 382

Hospital at Hilton Head 313

Hospital at West Philadelphia 363

Hospital, Blackburn '. 337

Hospital, Boston Free 344

Hospital, British regimental 352

Hospital camp at New Creek, Va.... 397

Hospital construction, principles of 324

Hospital, dead-house of 330

Hospital diet British army 570

Hospital diet British East India

hospitals 568

Hospital diet of British naval hos-
pitals 566

Hospital diet United States army ... 572

Hospital, Episcopal 347

Hospital gangrene in New York Hos-
pital 172

Hospital, general plan of. 330

Hospital, Good Samaritan, at St.

Louis 319

Hospital, Guy's 311

Hospital, Hammond, at Point, Look-
out 377

Hospital, Judiciary Square, at Wash-
ington 361

Hospital, King's College 320

Hospital, kitchen of 330

Hospital, laundry of. 330

Hospital, Lincoln, at Washington... 382

Hospital, Marine, at St. Louis 314

Hospital, McClellan, at Philadelphia 375

Hospital, mess-room of. 330

Hospital, military, at Arbour Hill.... 321

Hospital, military, at Malta 342

Hospital, military, at Vincennes 336

Hospital, military, at Woolwich 340

Hospital, Mower, at Chestnut Hill,

Philadelphia 371

Hospital, office of 330

Hospital, Pennsylvania 343

Hospital, Poyet's plan for 381

Hospital, proposed military, at Fort

Delaware 351

Hospital, Seminary, at Georgetown.. 318

Hospital, simplest form of 331

Hospital, St, Louis, at Turin 339

Hospital, surgery of 330

Hospital, United States Post 316

Hospital, Victoria, at Netley 317

Hospitals 305

Hospitals, administrative depart-
ment of 329

Hospitals, badly planned 311

Hospitals, best 390

Hospitals, composition of air of 426

Hospitals, field 387

Hospitals, form and general arrange-
ment of. 310

Hospitals, German 340

Hospitals, heating of 409

Hospitals, lighting of 399

Hospitals, location of. 306

Hospitals, materials for construc-
tion of 309

Hospitals, military, plans of Dr.

Tilton 358

Hospitals, military, should not be

near home 130

Hospitals, pavilion 361

Hospitals, temperature of 206

Hospitals, temporary, advantages of 397

INDEX.

601

Hospitals, temporary military

Hospitals, temporary, sites for

Hospitals, temporary, ventilation of

Hospitals, tent

Hospitals, tent, advantages of

Hospitals, ventilation of

Hot baths

Hot climates

Hotel-Dieu, condition of in 1786....
Hot water

Hot water, antiquity of use of as
heating agent

Hot water as a heating agent

House of Commons, Dr. Reid's plan
for ventilating

Human exhalations, deleterious cha-
racter of

Human exhalations, Trotter on

Hutchinson, Mr 37

Hut hospital of Naval Brigade,
Crimea

Hut hospitals

Huts

Huts, arrangement of

Huts, construction of

Huts, heating of.

Hydrocarbons

Hygiene of tents

Hygrometric properties of clothing
modified by color

Hypochondria

Idiocy

Idiosyncrasy

Illuminating gas

Illumination, artificial, impurities in

atmosphere from

Improvements in barracks

Indian-corn

Infusoria in atmosphere

Inherent qualities of clothing

Inorganic aliments

Insanity ;••

Intermittent fever kept up by habit.

Involuntary emissions

Iodine in atmosphere

Iodine, source of in atmosphere

Iron

353
354
355
387
450
421
237
264
433
225

419
417

444

167
171
,40

394
390
451
390
392
396
471
450

589
130

89
160

402
16
523
179
581
488
56
125
142
155
156
493

Jan Mayen, story of the Dutch sail-
ors who wintered at 300

Kidneys, the habitual diseases of.... 138

Larrey, M., on atmosphere of hos-

Latrines 6Z *> *»»

Latrines, ventilation of. 440

Lead in water •••••• ^ iy

Leblanc's experiments on confined
air

Leroy, M., on atmosphere of hos-
pitals 428

Leucorrhoea, habitual 144

Liebig on alcohol 539

Liebig on wine 546

Life, course of. 92

Life, length of 92

Life, stages of. 93

Light 206

Light, excessive... 209

Lighting of hospitals 399

Limbs, clothing of. 592

Lime, salts of useful in food 492

Locality 256

Londonderry, steamship, deaths

from bad air 168

Lower extremities 60

Lymphatic temperament 83

Madrid, air of 151

Magendie's, M., experiments 500

Malaria 179

Malaria attacks, in preference, the

white race 192

Malaria, attraction of for trees and

other organic materials 191

Malaria, its affinity for water 189

Malaria, laws governing 183

Malaria more active in night-time... 186
Malaria more potent at place of

origin 183

Malaria most active in low situa-
tions 184

Malaria moved by wind 188

Malaria, prevented from being ac-
tive by fires 192

Malaria, produced by turning up the

soil 191

Malaria, theories relative to 179

Malarious diseases prevented by

quinine.

192

Malarious influences 192

Malt liquors 547

Mammals, flesh of as food 510

Marshes 259

Masturbation 139

Maximum weight of meu 50

Maximum weight of women 50

McLeod, Dr., on deficient food in

the British army in the Crimea... 557

Means of ventilation 439

Measles caused by fungus 182

Meat 509

Meat, salt 511

Men, maximum weight of. 50

Men, minimum weight of 51

Mental emotion, influence of over

digestion 503.

Military necessity 13

Milk 504

Milk, composition of 505

Milk, condensed 508

G02

INDEX.

Milk, human, composition of 506

Milk, specific gravity of 606

Mineral waters 231

Minimum weight of men 51

Mitchell, Dr. J. K., on cryptogamic

origin of disease 175

Mitchell, Dr. S. W 42

Mitchell, Prof. J. K., on origin of

malaria 179

Mobility of thorax 42

Moist atmosphere, effects of on sys-
tem 177

Moleschott on alcohol 540

Mollusks as food 517

Morbid habits 127

Morbid habits of encephalon 127

Morbid habits of generative organs. 138
Morbid habits of organs of circula-
tion 132

Morbid habits of organs of diges-
tion 134

Morbid habits of organs of respira-
tion 133

Morbid habits of secretory and ex-
cretory organs 137

Morbid habits of special senses 131

Morphological matters in atmos-
phere 173

Morton's researches relative to cra-
nia 65

Mountains 257

Mouth, the 58

Miiller, his definition of tempera-
ment 77

Mustard 529

Myopia caused by habit 131

National Hotel disease 158

Natural ventilation 439

Neck, clothing of 591

Neck, the 59

Negroes, susceptibility of to disease 70

Negro race 69

Negro troops 70

Nervous system, morbid habits of... 127

Nervous temperament 87

Neuralgia 57

Newgate, typhus fever caused by

retained human exhalations in 172

New Mexico, climate of. 279

New York City Hospital, hospital

gangrene originating in 172

Nightingale, Miss, on hospital at

Scutari 430

Nitric acid in atmosphere 161

Nitrogenous alimentary principles.. 467
Non-essential constituents of atmos-
phere 151

Northers 199

Nose, the 58

Nostalgia 127

Nostalgia, means of preventing 129

Oats 524

Old Bailey 172

Old Bailey sessions 169

Organic exhalations from body, ex-
periment relative to 170

Organic matter in atmosphere, how

detected 172

Organic matter of atmosphere 166

Overcrowding, danger of. 389

Overcrowding, fatal effects of 154

Overcrowding in camps 452

Oxford assizes 169

Ozone 161

Ozone destroys malaria 163

Ozone destructive of life 164

Ozone, how formed 161

Ozone, influence of in causing

cholera 164

Ozone, properties of 162

Ozone, test for presence of 162

Ozone, theories in regard to 161

Paraffine ■ 400

Parisian commission on sulphuretted

hydrogen 156

Particular temperaments 80-

Pasteur's experiments on infusoria

in atmosphere 173

Pavilion principle 331

Peas 524

Pennsylvania Hospital 343

Pepper 527

Percy's, Dr., experiments relative

to alcohol 532

Peron's experiments 66

Phlegmatic temperament 83

Phosphorus 493

Plains 259

Police of camps 460

Population, density of in camps 452

Population, density of in towns 453

Potatoes 52-3

Potato starch 479

Pouchet on infusoria in atmosphere. 174

Presbyopia caused by habit 131

Preventable diseases 16

Psylles, immunity of to poison of

serpents .' 73

Ptosis, the 57

Pus cells in atmosphere 173

Putrefaction 468

Qualifications of recruits 18

Quetelet, M a 34, 50

Race 62

Race, American 67

Race, European 65

Race, influence of climate, etc. on... 62

Race, negro 69

Races, adaptability of to military

life 76

INDEX.

603

Races, degeneration caused by in-
termixture of 75

Races, improvement of 74

Rainwater 215

Ration of American soldier 563

Ration of British soldier 560

Ration of East Indian troops 562

Ration of French troops 562

Ration of Russian soldier 563

Recruit, age of 19

Recruits, qualifications of. 18

Recruits, special qualifications of... 53
Reid's, Dr., plan for ventilating

House of Commons 444

Reptiles as food 515

Resemblances transmitted heredi-
tarily 116

Respiration, morbid habits of organs

of 133

Respiratory power 49

Rice 524

Richardson, Dr. B. W., on defective

ventilation 434

Ridge ventilation 440

Rivers, mouths of 260

River water 216

Rumford's, Count, experiments rela-
tive to color and heat 587

Rye 524

Saccharine principles 472

Sago 478

Salisbury's, Dr., investigations rela-
tive to cause of measles 182

Salt 489

Salt, consequences of excessive use

of 490

Salt, necessity of as addition to

food 489

Sanguine temperament 80

Scalp and cranium 54

Schonbein on ozone as destroying

malaria 163

Scutari, bad state of barrack hos-
pital at, as regards ventilation.... 429

Sea-bathing 233

Sea-shore 260

Sea water 214

Secretory and excretory organs,

morbid habits of 137

Sex 107

Sex, diseases to which each is spe-
cially liable Ill

Sexes, differences between the.. 108, 111

Sexes, relative mortality of 108

Sexes, relative number of births ac-
cording to 109

Shoes 594

Shoes, India-rubber 596

Sickness as influenced by cold 204

Sick soldiers, food of 565

Silk as clothing 581

Simoom 199

Sirocco 199

Skin, the 61

Skin, the habitual diseases of 137

Skins of animals as clothing 581

Slaughter pens 400

Soil 250

Soil, configuration of 255

Soil, cultivation of 256

Soil, vegetation of 255

Soils, capacity of, for heat 251

Soils, capacity of, for moisture 252

Soils, retention of organic matters

by 253

Soldiers, stature of 26

Soups 513

Space, allowance of per patient 325

Space per man in barracks ' 447

Spasmodic croup, habitual 133

Special senses, morbid habits of 131

Spermaceti 400

Spinal cord, disease of 57

Spirometer 40, 42

Spring water 216

Stagnant water 216

Starch 473

Stark's experiments with textile fab-
rics 587

Stature of soldiers 26

St. Cloud, fever produced at. .. 428

Steam as a heating agent 416

Stearine 400

Stetho-goniometer 40

Stoves 414

Strabismus caused by habit 131

Sugar 480

Sulphur 493

Sulphuretted hydrogen 156

Sulphuretted hydrogen, effects of

when inhaled 157

Sulphuretted hydrogen, experiments

relative to effects of 157

Sulphuretted hydrogen, how de-
tected 159

Sulphuretted hydrogen is not iden-
tical with malaria 158

Surface covered by tents 451

Tallow 400

Tapioca 476

Tea 548

Tea, effects of 548

Tea, use of in armies 550

Temperament, choleric or bilious... 85

Temperament, definition of 78

Temperament, lymphatic or phleg-
matic 83

Temperament, nervous 87

Temperament, sanguine 80

Temperaments 77

Temperaments, number of 78

Temperaments, particular 80

604

INDEX.

Temperate climates 273

Temperature 200

Temperature of wards, importance

of regulating 420

Tent hospitals 387

Tent hospitals, advantages of 450

Tents 448

Tents and huts, arrangement of 451

Tents, hygiene of 450

Tents, surface covered by 451

Tepid water 225

Thirst 225

Thirst, false 225

Thompson, Dr. W. N 29

Thorax, circumference of 37

Thorax, mobility of 42

Tilton's, Dr., plan of military hos-
pital 358

Tobacco 552

Tobacco, effects of on system 554

Tobafeco, experiments with 554

Tous-les-mois 480

Troops, clothing of 592

Troops, negro 70

Trotter, Dr., on human exhalations. 171

Unfermented bread 520

United States, climate of 274

Upper extremities 60

Use of water 223

Van Buren, Prof. W. H., on preven-
tion of malarious diseases 192

Vegetable food 518

Vegetable substances used as cloth-
ing 579

Ventilation, artificial 443

Ventilation, means of. 439

Ventilation, natural 439

Ventilation of gas burners 406

Ventilation of hospitals 427

Ventilation of latrines 445

Ventilation, ridge 440

Villerme, M 34

Vinegar 529

Vital capacity 40

Vomiting, habitual 134

Wards 324

Wards, appendages to 327

Wards, arrangement of beds in 325

Wards, dimensions of 324

Wards, furniture of 386

Wards, windows in 326

Ward, typical plan of 328

Warm baths 237

Washing water 240

Water 213

Water, action of on lead 220

Water, amount of formed from com-
bustion of coal gas 404

Water, chemical means of purifying 249

Water-closets 328

Water, detection of organic con-
stituents of 228

Water, examination of 226

Water, hot, as a heating agent 417

Water, how contaminated by lead... 219
Water, impure, cholera produced

by 222

Water in atmosphere 175

Water, means of purifying 241

Water, microscopical examination of 229

Water, organic matters in 221

Water, pure, indispensable to health 218

Water, use of 223

Wax 399

Weak constitution 52

Weight 50

Weight, relation of to age 51

Weight, relation of to height 52

Well water 216

Wheat as food 518

Whey 508

Whisky 544

Winds 198

Wine 544

Wine, Liebig on 546

Women, maximum weight of 50

Wool as clothing 580

THE END.

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